機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性分析_《中國呼吸與危重監護雜志》

作者：

薛曉燕 ,  高占成

北京大學人民醫院呼吸科（北京 100044）;

關鍵詞：

呼出氣冷凝液機械通氣硝酸鹽/ 亞硝酸鹽一氧化氮臨床肺部感染評分

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目的探討機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性。方法選擇北京大學人民醫院重癥監護病房2006 年11 月至2007 年8 月間機械通氣的患者為研究對象。收集患者臨床資料, 觀察患者臨床轉歸, 計算臨床肺部感染評分( CPIS) ,并經氣管插管或氣管切開套管收集患者EBC 進行NO2 /NO3 水平測定。比較上機24 h 內不同CPIS評分患者的NO2 /NO3 水平, 不同NO2 /NO3 水平患者的3 d 內脫機例數和最終院內病死率。比較存活患者與死亡患者CPIS 評分和NO2 /NO3 水平的相關性。結果共收集患者76 例。入院24 h 內不同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, 隨著上機時間的延長, 存活和死亡患者NO2 /NO3 水平差異逐漸加大, 第7 d 差異有統計學意義[ ( 29. 32 ±9. 52) μmol / L 比( 37. 22 ±12. 03) μmol / L, P lt; 0. 01] 。直線相關分析顯示CPIS 評分與NO2 /NO3 水平呈正相關( r =0. 76, P lt; 0. 01, n =76) 。結論機械通氣患者EBC 中NO2 /NO3水平可以反映肺部感染的嚴重程度, 可能作為判斷預后、指導撤機的參考指標。

引用本文： 薛曉燕,高占成. 機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性分析. 中國呼吸與危重監護雜志, 2009, 09(4): 333-336. doi: 復制

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, 何權瀛, 尚穎, 等. 哮喘患者呼出氣冷凝液中硝酸鹽/亞硝酸鹽、白細胞介素4 和γ干擾素檢測的臨床意義. 中國呼吸與危重監護雜志.
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相關肺炎. 中華醫院感染學雜志, 2005, 15: 751-752.
7.	楊國輝, 王廣發. 臨床肺部感染評分對呼吸機相關肺炎患者預后的評價. 中華結核和呼吸雜志, 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測. 中國呼吸與危重監護雜志, 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, 何權瀛, 尚穎, 等. 哮喘患者呼出氣冷凝液中硝酸鹽/亞硝酸鹽、白細胞介素4 和γ干擾素檢測的臨床意義. 中國呼吸與危重監護雜志.
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相關肺炎. 中華醫院感染學雜志, 2005, 15: 751-752.
7. 楊國輝, 王廣發. 臨床肺部感染評分對呼吸機相關肺炎患者預后的評價. 中華結核和呼吸雜志, 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測. 中國呼吸與危重監護雜志, 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.

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