• 北京大學(xué)人民醫(yī)院呼吸科（北京 100044）;

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(duì)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(píng)分( CPIS) ,并經(jīng)氣管插管或氣管切開(kāi)套管收集患者EBC 進(jìn)行NO2 /NO3 水平測(cè)定。比較上機(jī)24 h 內(nèi)不同CPIS評(píng)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(píng)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(píng)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(cè)到第4 d、第7 d的NO2 /NO3 水平, 隨著上機(jī)時(shí)間的延長(zhǎng), 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(xiàn)相關(guān)分析顯示CPIS 評(píng)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(guó)呼吸與危重監(jiān)護(hù)雜志, 2009, 09(4): 333-336. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)呼吸與危重監(jiān)護(hù)雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

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(cè)的臨床意義. 中國(guó)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(píng)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(guó)輝, 王廣發(fā). 臨床肺部感染評(píng)分對(duì)呼吸機(jī)相關(guān)肺炎患者預(yù)后的評(píng)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(píng)分對(duì)無(wú)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(cè). 中國(guó)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. 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. 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(cè)的臨床意義. 中國(guó)呼吸與危重監(jiān)護(hù)雜志.
  3. 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. 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. 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. 6. 姜輝, 俞森洋. 臨床肺感染評(píng)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. 7. 楊國(guó)輝, 王廣發(fā). 臨床肺部感染評(píng)分對(duì)呼吸機(jī)相關(guān)肺炎患者預(yù)后的評(píng)價(jià). 中華結(jié)核和呼吸雜志, 2006, 29: 751-754.
  8. 8. 葉寰, 劉羽翔. 臨床肺部感染評(píng)分對(duì)無(wú)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(cè). 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2007, 11: 424-427.
  9. 9. Kharitonov SA. Exhaled markers of inflammatory lung diseases:ready for routine monitoring? Swiss Med Wkly, 2004, 134: 175-192.
  10. 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. 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. 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. 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. 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. 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. 16. , 8: 131-134.

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