本文選題：煙霧吸入性損傷　切入點(diǎn)：全氟化碳　出處：《新鄉(xiāng)醫(yī)學(xué)院》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：背景 煙霧吸入性損傷病死率高,目前無(wú)特效療法。動(dòng)物實(shí)驗(yàn)表明應(yīng)用全氟化碳(Perfluorocarbon,PFC)可明顯改善煙霧吸入性損傷的肺部及全身炎癥反應(yīng)、改善氧合。 目的 本研究通過(guò)對(duì)臨床上燒傷合并中重度煙霧吸入性損傷患者行氣管內(nèi)分次注入PFC治療,觀察治療效果、肺部氧合功能及相關(guān)炎性介質(zhì)水平,探討PFC對(duì)煙霧吸入性損傷的肺保護(hù)作用,為進(jìn)一步臨床應(yīng)用提供理論支持。 方法 1.符合入選標(biāo)準(zhǔn)的燒傷合并中重度吸入性損傷患者按隨機(jī)數(shù)字分組法分入試驗(yàn)組和對(duì)照組。對(duì)照組給予抗感染、營(yíng)養(yǎng)支持、抗休克及對(duì)癥支持治療等。試驗(yàn)組在此基礎(chǔ)上經(jīng)氣管切開(kāi)處氣管套管給予15mlPFC(1.672g/ml)每12小時(shí)一次,共3天。 2.所有入選患者按照急性生理和慢性健康評(píng)估(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)評(píng)分標(biāo)準(zhǔn)分別于入院時(shí)及治療3d后評(píng)分�；颊哂谥委熐�、治療3d后抽取動(dòng)脈血?dú)?觀察并記錄肺動(dòng)態(tài)順應(yīng)性、肺泡動(dòng)脈氧分壓差、氧合指數(shù)�；颊哂谥委熐凹爸委�3天后行支氣管肺泡灌洗,將回收的支氣管肺泡灌洗液(broncho-alveolar lavage fluid,BALF)標(biāo)本離心后取上清液裝EP管于-80℃超低溫冰箱內(nèi)保存；離心沉淀的部分立即行細(xì)胞分類計(jì)數(shù)(中性粒細(xì)胞、巨噬細(xì)胞)。治療前及治療3天后抽取靜脈血標(biāo)本離心后上清液裝EP管于-80℃超低溫冰箱內(nèi)保存。用雙抗體夾心ELISA法檢測(cè)定血漿和BALF中炎癥介質(zhì)(TNF-α、IL-8、NF-κB)的濃度。 結(jié)果 1.燒傷合并中重度煙霧吸入性損傷患者12例入選試驗(yàn)組,11例入選對(duì)照組。經(jīng)治療后,試驗(yàn)組APACHE Ⅱ評(píng)分分值明顯下降(P0.05)。 2.與對(duì)照組比較,試驗(yàn)組患者的氧合指數(shù)升高,但并無(wú)顯著統(tǒng)計(jì)學(xué)差異(P0.05)。經(jīng)治療3天后兩組患者的肺動(dòng)態(tài)順應(yīng)性均有所升高、肺泡動(dòng)脈氧分壓差均有所下降,與對(duì)照組比較,試驗(yàn)組肺動(dòng)態(tài)順應(yīng)性、肺泡動(dòng)脈氧分壓改善明顯(P0.05)。 3.經(jīng)治療3天后兩組患者BALF中中性粒細(xì)胞所占比例均降低,巨噬細(xì)胞所占比例均升高。以試驗(yàn)組治療前后進(jìn)行自身比較,患者BALF中中性粒細(xì)胞所占比例明顯降低(P0.01),巨噬細(xì)胞所占比例明顯升高(P0.05)。與對(duì)照組比較,試驗(yàn)組BALF中的中性粒細(xì)胞所占比例明顯降低(P0.01),巨噬細(xì)胞所占比例明顯升高(P0.05)。 4.與對(duì)照組比較,試驗(yàn)組在氣管內(nèi)滴入PFC治療3天后,BALF中TNF-α的濃度降低,但未見(jiàn)顯著統(tǒng)計(jì)學(xué)差異(P0.05)。以試驗(yàn)組治療前后進(jìn)行自身比較,經(jīng)治療3天后患者BALF中IL-8、NF-κB的濃度降低明顯(P0.05)。 5.經(jīng)治療后,試驗(yàn)組與對(duì)照組患者血漿中TNF-α、IL-8及NF-κB濃度均未有明顯改善。 結(jié)論 1.氣管內(nèi)滴入PFC治療煙霧吸入性損傷患者,可明顯改善肺泡動(dòng)脈氧分壓差和肺動(dòng)態(tài)順應(yīng)性,改善煙霧吸入性損傷患者的肺部氣體交換。 2.氣管內(nèi)滴入PFC可使煙霧吸入性損傷的早期肺組織內(nèi)中性粒細(xì)胞的數(shù)量明顯減少,巨噬細(xì)胞數(shù)量增加,促進(jìn)炎癥吸收,對(duì)早期肺損傷有保護(hù)作用。 3.氣管內(nèi)滴入PFC治療煙霧吸入性損傷患者,可明顯減少早期肺泡炎性因子如IL-8、NF-κB的釋放,發(fā)揮局部抗炎作用。
[Abstract]:background
Smoke inhalation injury has a high mortality rate, and there is no specific treatment at present. Animal experiments show that Perfluorocarbon (PFC) can significantly improve the lung and systemic inflammatory response and improve oxygenation in smoke inhalation injury.
objective
Through the study of clinical burn combined with severe smoke inhalation injury in patients with intratracheal injection of PFC treatment, observe the treatment effect, pulmonary oxygenation function and related inflammatory mediators, to investigate the protective effect of PFC inhalation lung injury of smoke, for further clinical application to provide theoretical support.
Method
1. meet the criteria of burn patients with severe inhalation injury patients were divided into experiment group and control group according to the random number table method. The control group was given anti infection, nutrition support, anti shock and symptomatic treatment. The experimental group on the basis of tracheotomy at the tracheal tube with 15mlPFC (1.672g/ml) every 12 hours, a total of 3 days.
2. of all patients in accordance with acute physiology and chronic health evaluation (acute physiology and chronic health evaluation II, APACHE II) standard for evaluation respectively at admission and after treatment 3D score. The patients before treatment, after treatment of 3D extraction of arterial blood gas, observe and record the dynamic lung compliance, arterial oxygen pressure, oxygenation index. Before treatment and after 3 days in patients underwent bronchoalveolar lavage, bronchoalveolar lavage fluid will be recovered (broncho-alveolar lavage, fluid, BALF) sample was centrifuged and the supernatant was loaded EP tube at -80 deg.c for ultra low temperature refrigerator; centrifugal sedimentation part of the immediate cell count (neutrophils, macrophages) treatment. Before and after 3 days of treatment, blood samples were collected after centrifugation the supernatant containing EP tube at -80 deg.c for ultra low temperature refrigerator. Detection of inflammatory mediators in plasma and BALF with the method of double antibody sandwich ELISA (TNF- The concentration of alpha, IL-8, NF- kappa B).
Result
1. 12 cases of burn combined with moderate and severe smoke inhalation injury were enrolled in the experimental group and 11 cases were enrolled in the control group. After treatment, the score of APACHE II score in the experimental group decreased significantly (P0.05).
2. compared with the control group, the experimental group oxygenation index increased, but no significant difference (P0.05). After 3 days of treatment by dynamic lung compliance of patients in two groups were increased, arterial oxygen partial pressure difference decreased, compared with the control group, the experimental group dynamic lung compliance, Alveolar arterial oxygen partial pressure significantly improved (P0.05).
3. after treatment for 3 days after the two groups of neutrophils in patients with BALF ratio decreased, the proportion of macrophages were increased. Compared to the experimental group before and after treatment, accounted for the proportion of neutrophils in BALF patients were significantly decreased (P0.01), the proportion of macrophages was significantly increased (P0.05) and the control group. For comparison, neutrophil test in group BALF decreased significantly (P0.01), the proportion of macrophages increased significantly (P0.05).
4. compared with the control group, after 3 days of intratracheal instillation of PFC, the concentration of TNF- alpha in BALF decreased, but there was no significant difference (P0.05). In the experimental group, the concentration of IL-8 and NF- NF- B in BALF decreased significantly after 3 days treatment (P0.05).
5. after treatment, the concentrations of TNF- alpha, IL-8 and NF- kappa B in the plasma of the experimental group and the control group were not significantly improved.
conclusion
1. intratracheal instillation of PFC in the treatment of smoke inhalation injury can significantly improve Alveolar arterial oxygen pressure difference and pulmonary dynamic compliance, and improve lung gas exchange in patients with smoke inhalation injury.
2. intratracheal instillation of PFC can reduce the number of neutrophils in the early stage of smoke inhalation injury, increase the number of macrophages, promote the absorption of inflammation, and protect the early lung injury.
3. intratracheal infusion of PFC in patients with smoke inhalation injury can significantly reduce the release of early alveolar inflammatory factors such as IL-8, NF- kappa B, and play a local anti-inflammatory effect.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563

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