兰州大学机构库 >学院待认领
SuPAR、RAGE、PCT及CRP联合检测在ARDS患者呼吸机捆绑式治疗中的应用研究
Alternative TitleApplication research of detecting suPAR, RAGE, PCT and CRP levels in acute respiratory distress syndrome patients with ventilator bundle
杨静
Thesis Advisor董晨明
2014-05-21
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword急性呼吸窘迫综合征 呼吸机捆绑式治疗 可溶性尿激酶型纤溶酶原激活物受体    高级糖基化终产物受体
Abstract目的:通过检测血浆/血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)、高级糖基化终产物受体(RAGE)、降钙素原(PCT)及C反应蛋白(CRP)水平变化,探讨呼吸机捆绑式治疗对急性呼吸窘迫综合症(ARDS)患者预后的影响。方法:选取本院重症监护病房(ICU)2013年1月至2013年12月接受有创机械通气治疗的ARDS患者共54例,予呼吸机捆绑式治疗措施,包括①床头抬高30°~45°;②每日唤醒并进行拔管评估即脱机试验(SBT);③预防消化性溃疡;④预防深静脉血栓(DVT);⑤洗必泰口腔护理、持续声门下吸痰(CASS)。依据实施的情况(依存性)分为完全呼吸机捆绑式治疗组(VB组)和非完全呼吸机捆绑式治疗组(NVB组)。比较两组患者机械通气时间、ICU住院时间、呼吸机相关性肺炎(VAP)发生率、多器官功能障碍综合征(MODS)发生率、其它并发症的发生率及28d病死率,并检测患者治疗前后血浆/血清suPAR、RAGE、PCT及CRP水平,比较其变化和差异。结果:①两组患者性别、年龄、APACHE Ⅱ评分及PaO2/FiO2等基础状态无明显差异(P > 0.05)。②相关性分析:患者年龄与PaO2/FiO2负相关(P < 0.05);PaO2/FiO2与suPAR、RAGE、PCT及CRP水平均负相关(P < 0.01或P < 0.05);suPAR、PAGE、PCT水平两两正相关(P < 0.01)。③两组患者治疗前血浆/血清suPAR、RAGE、PCT及CRP水平无明显差异。④与治疗前相比,治疗后两组患者血浆/血清suPAR、RAGE、PCT及CRP水平均下降,差异有统计学意义(P < 0.01)。⑤治疗后VB组患者血浆suPAR及RAGE水平下降较NVB组明显,差异有统计学意义(P < 0.01),而PCT及CRP水平下降无明显差异。⑥VB组患者机械通气时间、ICU住院时间、VAP发生率均低于NVB组,差异有统计学意义(P < 0.05),而28d病死率、其它相关并发症发生率无明显差异。结论:①血浆/血清suPAR、RAGE、PCT及CRP水平与ARDS患者病情严重程度相关;②呼吸机捆绑式治疗措施能够影响ARDS患者血浆/血清suPAR、RAGE、PCT及CRP水平,从而减轻炎性反应,改善患者预后;③呼吸机捆绑式治疗措施能显著降低ARDS患者VAP的发生率、机械通气时间及ICU住院时间,对患者预后产生积极影响;④呼吸机捆绑式治疗实施的依从性能够影响ARDS患者预后,全依存者保持较低的并发症发生率和死亡率。
Other AbstractObjective:By detecting the levels of plasma/serum soluble urokinase plasminogen activator receptor (suPAR), receptor of advanced glycation end products (RAGE), procalcitonin (PCT) and c-reactive protein (CRP), to investigate the prognosis of ventilator bundle in patients with acute respiratory distress syndrome (ARDS). Methods:A total of 54 cases of ARDS patients were selected in our research, who were received treatment of invasive mechanical ventilation in our hospital intensive care unit (ICU) between January 2013 and December 2013. All of the patients were given ventilator bundle, including, ① elevation of the head of the bed to 30–45°. ②daily interruption of sedation and spontaneous breathing Test (SBT). ③gastric ulcer prophylaxisr. ④deep vein thrombosis (DVT) prophylaxis. ⑤oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions(CASS). These patients were divided into two groups according to the situation of the implementation (dependence), VB group achieved all application of ventilator bundle measures(n=29), and NVB group did not reach all the application of ventilator bundle measures(n=25). Compare the mechanical ventilation time, ICU length of hospital stay, the incidence rate of ventilator associated pneumonia (VAP), the incidence rate of other complications and mortality rate of 28 days between the two groups of patients. Detect the plasma/serum suPAR, RAGE, PCT and CRP level before and after treatment, and compare the changes and differences. Results:①There was no significant difference in ratio of sex, mean age, acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score and oxygenation index (PaO2 / FiO2), as to as other basic state between two groups (P > 0.05). ②Correlation analysis: Age is negatively related to the PaO2 / FiO2 (P < 0.05). PaO2 / FiO2 was negative correlation with suPAR, RAGE, PCT and CRP (P < 0.01 or P < 0.05). Plasma suPAR, PAGE, PCT levels were positive correlation (P < 0.01). Mechanical ventilation time and ICU length of hospital stay were positive correlation (P < 0.01). ③There was no obvious difference of plasma/serum suPAR, RAGE, PCT and CRP levels between two groups before treatment. The levels of these markers were decreased after treatment. ④Compared with before treatment, the plasma/serum suPAR, RAGE, PCT and CRP levels decreased after treatment in two groups of patients, the difference was statistically significant (P < 0.01). ⑤The plasma suPAR an...
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Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/223914
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
杨静. SuPAR、RAGE、PCT及CRP联合检测在ARDS患者呼吸机捆绑式治疗中的应用研究[D]. 兰州. 兰州大学,2014.
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