目的 探討機(jī)械通氣患者呼出氣冷凝液( EBC) 中硝酸鹽/ 亞硝酸鹽( NO2 /NO3 ) 水平與肺部感染的相關(guān)性。方法 選擇北京大學(xué)人民醫(yī)院重癥監(jiān)護(hù)病房2006 年11 月至2007 年8 月間機(jī)械通氣的患者為研究對象。收集患者臨床資料, 觀察患者臨床轉(zhuǎn)歸, 計(jì)算臨床肺部感染評分( CPIS) ,并經(jīng)氣管插管或氣管切開套管收集患者EBC 進(jìn)行NO2 /NO3 水平測定。比較上機(jī)24 h 內(nèi)不同CPIS評分患者的NO2 /NO3 水平, 不同NO2 /NO3 水平患者的3 d 內(nèi)脫機(jī)例數(shù)和最終院內(nèi)病死率。比較存活患者與死亡患者CPIS 評分和NO2 /NO3 水平的相關(guān)性。結(jié)果 共收集患者76 例。入院24 h 內(nèi)不同CPIS 評分組NO2 /NO3 水平兩兩比較有顯著差異( P lt; 0. 01) , CPIS≤ 3、CPIS 3 ～6 和CPIS gt; 6 患者NO2 /NO3 水平分別為( 23. 31 ±5. 79) 、( 28. 72 ±9. 10) 和( 35. 42 ±12. 10) μmol / L。NO2 /NO3 水平越低的患者早期脫機(jī)的比例越高, 病死率越低。24 例存活患者和23 例死亡患者檢測到第4 d、第7 d的NO2 /NO3 水平, 隨著上機(jī)時(shí)間的延長, 存活和死亡患者NO2 /NO3 水平差異逐漸加大, 第7 d 差異有統(tǒng)計(jì)學(xué)意義[ ( 29. 32 ±9. 52) μmol / L 比( 37. 22 ±12. 03) μmol / L, P lt; 0. 01] 。直線相關(guān)分析顯示CPIS 評分與NO2 /NO3 水平呈正相關(guān)( r =0. 76, P lt; 0. 01, n =76) 。結(jié)論 機(jī)械通氣患者EBC 中NO2 /NO3水平可以反映肺部感染的嚴(yán)重程度, 可能作為判斷預(yù)后、指導(dǎo)撤機(jī)的參考指標(biāo)。
引用本文： 薛曉燕,高占成. 機(jī)械通氣患者呼出氣冷凝液中硝酸鹽/ 亞硝酸鹽水平與肺部感染的相關(guān)性分析. 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 09(4): 333-336. doi: 復(fù)制
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| 2. | 陳燕文, 何權(quán)瀛, 尚穎, 等. 哮喘患者呼出氣冷凝液中硝酸鹽/亞硝酸鹽、白細(xì)胞介素4 和γ干擾素檢測的臨床意義. 中國呼吸與危重監(jiān)護(hù)雜志. |
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| 4. | Luna CM, Blanzaco D, Niederman MS, et al. resolution of ventilatorassociated pneumonia: prospective evalution of the clinical pulmonary infection score as an early clinical predictor of tcome. Crit Care Med, 2003, 31: 676-682. |
| 5. | American Thoracic Society Workshop. ATS Workshop Proceedings:Exhaled nitric oxide and nitric oxide oxidative metabolism in exhaled breath condensate: executive summary. Am J Respir Crit Care Med, 2006, 173: 811-813. |
| 6. | 姜輝, 俞森洋. 臨床肺感染評分診斷通氣機(jī)相關(guān)肺炎. 中華醫(yī)院感染學(xué)雜志, 2005, 15: 751-752. |
| 7. | 楊國輝, 王廣發(fā). 臨床肺部感染評分對呼吸機(jī)相關(guān)肺炎患者預(yù)后的評價(jià). 中華結(jié)核和呼吸雜志, 2006, 29: 751-754. |
| 8. | 葉寰, 劉羽翔. 臨床肺部感染評分對無創(chuàng)通氣治療慢性阻塞性肺疾病急性加重期患者呼吸衰竭的療效預(yù)測. 中國呼吸與危重監(jiān)護(hù)雜志, 2007, 11: 424-427. |
| 9. | Kharitonov SA. Exhaled markers of inflammatory lung diseases:ready for routine monitoring? Swiss Med Wkly, 2004, 134: 175-192. |
| 10. | Ganas K, Loukides S, Papatheodorou G, et al. Total nitrite/ nitrate in expired breath condensate of patients with asthma. Respir Med,2001, 95: 649-654. |
| 11. | Kostikas K, Papatheodorou G, Ganas K, et al. pH in expired breath condensate of patients with inflammatory airway diseases. Am J Respir Crit Care Med, 2002, 165: 1364-1370. |
| 12. | Kharitonov SA, Donnelly LE, Montuschi P, et al. Dose-dependent onset and cessation of action of inhaled budesonide on exhaled nitric oxide and symptoms in mild asthma. Thorax, 2002, 57: 889-896. |
| 13. | Liu J, Sandrini A, Thurston M C. Nitric oxide and exhaled breath nitrite /nitrates in chronic obstructive pulmonary disease patients.Respiration, 2007, 74: 617-623. |
| 14. | Corradi M, Pesci A, Casana R, et al. Nitrate in exhaled breath condensate of patients with different airway diseases. Nitric Oxide,2003, 8: 26-30. |
| 15. | Romero PV, Rodríguez B, Martínez S, et al. Analysis of oxidative stress in exhaled breath condensate from patients with severe pulmonary infections. Arch Bronconeumol, 2006, 42: 113-119. |
| 16. | , 8: 131-134. |
- 1. Horváth I, Hunt J, Barnes PJ, et al. Exhaled breath condensate:methodological recommendations and unresolved questions. Eur Respir J, 2005, 26: 523-548.
- 2. 陳燕文, 何權(quán)瀛, 尚穎, 等. 哮喘患者呼出氣冷凝液中硝酸鹽/亞硝酸鹽、白細(xì)胞介素4 和γ干擾素檢測的臨床意義. 中國呼吸與危重監(jiān)護(hù)雜志.
- 3. Tee AK, Hui KP. Effect of spirometric maneuver, nasal clips, and submaximal inspiratory effort on measurement of exhaled nitric oxide levels in asthmatic patients. Chest, 2005 , 127, 131-134 .
- 4. Luna CM, Blanzaco D, Niederman MS, et al. resolution of ventilatorassociated pneumonia: prospective evalution of the clinical pulmonary infection score as an early clinical predictor of tcome. Crit Care Med, 2003, 31: 676-682.
- 5. American Thoracic Society Workshop. ATS Workshop Proceedings:Exhaled nitric oxide and nitric oxide oxidative metabolism in exhaled breath condensate: executive summary. Am J Respir Crit Care Med, 2006, 173: 811-813.
- 6. 姜輝, 俞森洋. 臨床肺感染評分診斷通氣機(jī)相關(guān)肺炎. 中華醫(yī)院感染學(xué)雜志, 2005, 15: 751-752.
- 7. 楊國輝, 王廣發(fā). 臨床肺部感染評分對呼吸機(jī)相關(guān)肺炎患者預(yù)后的評價(jià). 中華結(jié)核和呼吸雜志, 2006, 29: 751-754.
- 8. 葉寰, 劉羽翔. 臨床肺部感染評分對無創(chuàng)通氣治療慢性阻塞性肺疾病急性加重期患者呼吸衰竭的療效預(yù)測. 中國呼吸與危重監(jiān)護(hù)雜志, 2007, 11: 424-427.
- 9. Kharitonov SA. Exhaled markers of inflammatory lung diseases:ready for routine monitoring? Swiss Med Wkly, 2004, 134: 175-192.
- 10. Ganas K, Loukides S, Papatheodorou G, et al. Total nitrite/ nitrate in expired breath condensate of patients with asthma. Respir Med,2001, 95: 649-654.
- 11. Kostikas K, Papatheodorou G, Ganas K, et al. pH in expired breath condensate of patients with inflammatory airway diseases. Am J Respir Crit Care Med, 2002, 165: 1364-1370.
- 12. Kharitonov SA, Donnelly LE, Montuschi P, et al. Dose-dependent onset and cessation of action of inhaled budesonide on exhaled nitric oxide and symptoms in mild asthma. Thorax, 2002, 57: 889-896.
- 13. Liu J, Sandrini A, Thurston M C. Nitric oxide and exhaled breath nitrite /nitrates in chronic obstructive pulmonary disease patients.Respiration, 2007, 74: 617-623.
- 14. Corradi M, Pesci A, Casana R, et al. Nitrate in exhaled breath condensate of patients with different airway diseases. Nitric Oxide,2003, 8: 26-30.
- 15. Romero PV, Rodríguez B, Martínez S, et al. Analysis of oxidative stress in exhaled breath condensate from patients with severe pulmonary infections. Arch Bronconeumol, 2006, 42: 113-119.
- 16. , 8: 131-134.