Donnelly T J, Meade P, Jagels M, Cryer H G, Law M M, Hugli T E, Shoemaker W C, Abraham E
Department of Medicine, UCLA Medical Center.
Crit Care Med. 1994 May;22(5):768-76. doi: 10.1097/00003246-199405000-00010.
The adult respiratory distress syndrome (ARDS) is a frequent complication after severe accidental trauma. This study examines the hypothesis that increased systemic concentrations of proinflammatory cytokines, endotoxin, or complement fragments may predict the development of ARDS.
Prospective, observational study.
Two Level I university trauma centers.
Fifteen severely injured patients (Injury Severity Score of > or = 25).
Standard emergency department, operating room, and intensive care unit management.
Plasma samples were obtained at 4-hr intervals from the time of injury and were assayed for concentrations of endotoxin, tumor necrosis factor-alpha, interleukin (IL)-1 beta, IL-6, IL-8, and complement fragments C3a and C4a. Hemodynamic and oxygen metabolism variables also were measured at 4-hr intervals after injury. Seven patients developed ARDS and eight patients did not. The PaO2/FIO2 ratio was significantly decreased in the patients with ARDS compared with non-ARDS patients as early as 4 hrs postinjury, and remained significantly decreased throughout the initial 24 hrs after severe accidental injury. Plasma IL-8, IL-6, C3a, and C4a concentrations were markedly increased starting in the immediate postinjury period in both ARDS and non-ARDS patients, but no significant differences were found between the two groups until 16 hrs after injury when plasma IL-8, C3a, and C4a concentrations became significantly higher in the ARDS group. Neither the ARDS nor non-ARDS patients showed the presence of circulating IL-1 beta, TNF-alpha, or endotoxin at any postinjury time point.
These results demonstrate that measurements of plasma concentrations of proinflammatory cytokines, endotoxin, or complement fragments are not helpful in predicting the development of ARDS after severe accidental injury.
成人呼吸窘迫综合征（ARDS）是严重意外创伤后常见的并发症。本研究检验以下假设：促炎细胞因子、内毒素或补体片段的全身浓度升高可能预示ARDS的发生。
前瞻性观察性研究。
两个一级大学创伤中心。
15名重伤患者（损伤严重度评分≥25）。
标准的急诊科、手术室和重症监护病房管理。
从受伤时起每隔4小时采集血浆样本，检测内毒素、肿瘤坏死因子-α、白细胞介素（IL）-1β、IL-6、IL-8以及补体片段C3a和C4a的浓度。受伤后每隔4小时还测量血流动力学和氧代谢变量。7名患者发生ARDS，8名患者未发生。与未发生ARDS的患者相比，发生ARDS的患者在受伤后4小时PaO2/FIO2比值就显著降低，且在严重意外受伤后的最初24小时内一直显著降低。ARDS和未发生ARDS的患者在受伤后即刻血浆IL-8、IL-6、C3a和C4a浓度均显著升高，但两组之间直到受伤后16小时才出现显著差异，此时ARDS组血浆IL-8、C3a和C4a浓度明显更高。在任何受伤后的时间点，ARDS患者和未发生ARDS的患者均未检测到循环中的IL-1β、TNF-α或内毒素。
这些结果表明，测量促炎细胞因子、内毒素或补体片段的血浆浓度无助于预测严重意外受伤后ARDS的发生。
