中文摘要：

目的 探讨呼吸重症监护病房（RICU）慢性阻塞性肺疾病（COPD）机械通气患者气道炎症反应与预后的关系.方法 30例COPD机械通气患者按预后分为存活组（16例）和死亡组（14例）,采用自行设计的呼出气冷凝液（EBC）收集器收集机械通气1、3、5和7 d呼气端的EBC,用化学荧光法测定EBC中过氧化氢（H2O2）浓度,用酶联免疫吸附法测定EBC中白细胞介素-6（IL-6）含量.结果 ①存活组EBC中H2O2和IL-6含量逐渐下降,机械通气3、5、7 d较1 d明显降低[H2O2（μmol/L）：0.10±0.03、0.06±0.03、0.04±0.03比0.19±0.14,IL-6（ng/L）：11.11±2.39、10.35±2.09、8.89±2.63比14.45±6.03,均P〈0.05];且7 d时EBC中H2O2浓度较3 d明显降低（P〈0.05）.②死亡组EBC中H2O2和IL-6含量逐渐升高,机械通气5 d和7 d EBC中H2O2浓度较1 d明显升高（0.16±0.15、0.25±0.16比0.05±0.03,均P〈0.05）;机械通气3、5和7 d IL-6含量较1 d明显升高（9.36±2.38、10.55±2.33、14.05±4.23比6.87±3.47,均P〈0.05）;7 d时EBC中H2O2和IL-6含量较3 d、5 d明显升高（均P〈0.05）.③与存活组比较,死亡组机械通气1 d EBC中H2O2和IL-6含量均明显降低（均P〈0.05）;3 d时差异无统计学意义（均P〉0.05）;5 d时H2O2浓度明显升高（P〈0.05）;7 d时H2O2和IL-6含量均明显升高（均P〈0.05）.④存活组和死亡组机械通气患者EBC中H2O2浓度和IL-6含量与急性生理学与慢性健康状况评分系统Ⅱ、Ⅲ（APACHEⅡ、Ⅲ）评分均无相关性（均P＞0.05）.结论 EBC中H2O2水平和IL-6含量的高低与预后有关,故可作为COPD机械通气患者气道炎症反应的重要监测指标,并可作为评估其治疗和预后的重要监测指标.

英文摘要：

Objective To explore the relationship of inflammatory response of the respiratory tract and prognosis of chronic obstructive pulmonary diseases （COPD） patients undergoing mechanical ventilation （MV） in respiratory intensive care unit （RICU）. Methods Thirty patients with COPD undergoing MV were involved in the study, and divided into survival group （n=16） and non-survival group （n=14）. Exhaled breath condensate （EBC） was collected on day 1,3,5,7 after MV. The concentration of hydrogen peroxide （H2O2） in EBC was measured fluorimetrically. The content of interleukin-6（IL-6） in EBC was measured by enzyme-linked immunosorbent assay （ELISA）. Results ①The significantly lower H2O2 and IL-6 levels in the survival group were observed on days 3,5 and 7 compared with those of day 1 after MV [H2O2 （μmol/L）： 0.10±0.03, 0.06±0.03, 0.04±0.03 vs.0.19±0.14,IL-6 （ng/L）：11.11±2.39,10.35±2.09,8.89±2.63vs. 14.45±6.03,all P〈0.05].A significantly lower H2O2 level was observed on day 7 compared with that of day 3 （P〈0.05）.②A significantly higher H2O2 level in the non-survival group was observed on days 5 and 7 compared with that of day 1 （0.16±0.15,0.25±0.16 vs.0.05±0.03, both P〈0.05）.A significantly higher IL-6 level was observed on days 3,5 and 7 compared with that of day 1 （9.36±2.38, 10.55±2.33, 4.05±4.23 vs. 6.87±3.47, all P〈0.05）. The significantly higher H2O2 and IL-6 levels in non-survival group were observed on day 7 compared with those of days 3 and 5 （all P〈0.05）. ③The significantly lower H2O2 and IL-6 levels in non-survivors were observed on day 1 after MV compared with survivors （both P〈0.05）. There were no marked differences in levels of H2O2 and IL-6 between non-survivors and survivors on day 3 （both P〉0.05）. A significantly higher H2O2 level in non-survivors was observed compared with survivors on day 5 （P〈0.05）. In addition, the significantly higher H2O2 and IL-6 levels in non-survivors were observed on day 7