Baughman R P, Gunther K L, Rashkin M C, Keeton D A, Pattishall E N
Division of Pulmonary and Critical Care Medicine, University of Cincinnati, Ohio 45267-0564, USA.
Am J Respir Crit Care Med. 1996 Jul;154(1):76-81. doi: 10.1164/ajrccm.154.1.8680703.
We studied paired bronchoalveolar lavage (BAL) in patients with sepsis-associated acute respiratory distress syndrome (ARDS). Patients were evaluated at one institution and underwent bronchoscopy with BAL within 48 h of the onset of ARDS. Patients were restudied with bronchoscopy and BAL after 4 d of treatment. Fifty-eight patients were initially studied, with 44 patients having follow-up bronchoscopy after 4 d. The overall 30-d survival for the ARDS group was 60%. In the initial lavage, there was no difference in the neutrophils between the survivors and nonsurvivors (survivors: 59 [0-98]%; Median [Range]; nonsurvivors: 55 [0-92]%). The follow-up lavage demonstrated a significant drop in the neutrophils for the survivors (36 [4-89]%, p < 0.002) which was not seen for the nonsurvivors (70 [26-95]%). Initial IL-8 concentrations in the BAL fluid were not significantly different between the two groups. In the follow-up lavage, there was a significant fall for the IL-8 concentrations for the survivors but not the nonsurvivors. We conclude that neutrophil influx in ARDS may rapidly resolve within a week of the onset of ARDS. The resolution of neutrophils was associated with a good prognosis.
我们对脓毒症相关急性呼吸窘迫综合征（ARDS）患者进行了配对支气管肺泡灌洗（BAL）研究。患者在一家机构接受评估，并在ARDS发病48小时内接受BAL支气管镜检查。治疗4天后，患者再次接受支气管镜检查和BAL。最初研究了58例患者，其中44例患者在4天后接受了随访支气管镜检查。ARDS组的30天总生存率为60%。在初次灌洗中，幸存者和非幸存者的中性粒细胞无差异（幸存者：59[0-98]%；中位数[范围]；非幸存者：55[0-92]%）。随访灌洗显示，幸存者的中性粒细胞显著下降（36[4-89]%，p<0.002），而非幸存者未见下降（70[26-95]%）。两组BAL液中初始IL-8浓度无显著差异。在随访灌洗中，幸存者的IL-8浓度显著下降，而非幸存者则未下降。我们得出结论，ARDS中中性粒细胞的流入可能在ARDS发病一周内迅速消退。中性粒细胞的消退与良好的预后相关。
