| Abstract: | 研究背景:活性氧化物 (Reactive Oxygen Species, ROS)的產生會影響到橫膈肌的收縮功能。在動物實驗及人體研究中發現，使用呼吸器(mechanical ventilation)會導致橫膈肌萎縮，進一步降低橫膈肌收縮力，而氧化壓力是造成此現象的主要原因。
研究目的:試圖了解呼吸器脫離成功組與失敗組的血中氧化壓力指標－異前列腺素 (8-iso-PGF2α)是否有無差異。
研究方法:觀察型個案對照研究，收取加護病房使用呼吸器大於24小時，符合呼吸器脫離條件之病患，利用T-Piece方式給予30分鐘的自主呼吸測試 (Spontaneous Breathing Trial, SBT)。通過30分鐘自主呼吸測試的病患即為呼吸器脫離成功組 (Weaning Success)；未通過30分鐘的呼吸測試或拔管後48小時之內重插管之病患即為呼吸器脫離失敗組 (Weaning Failure)。自主呼吸測試前5分鐘會採集受試者血液，過去病史以及臨床生理參數。
研究結果:共收錄28個呼吸器脫離成功及13個呼吸器脫離失敗的病人。白蛋白 (Albumin)、血中尿素氮 (Blood Urea Nitrogen, BUN)、體液滯留量 (Input / Output, I/O)、每分鐘通氣量 (Minute Ventilation, MV)在呼吸器脫離成功組及失敗組之間呈現顯著差異；異前列腺素 (8-iso PGF2α)表現量在呼吸器脫離成功組及失敗組之間並無呈現顯著差異(p = 0.8)；但8-iso PGF2α表現量與SOFA Score有顯著的正相關性(ρ = 0.421, p = 0.006)；呼吸器使用天數(ρ = 0.433, p = 0.005)也有顯著的正相關性；與Albumin有顯著的負相關性(ρ = -0.383, p = 0.016)。
結論與建議: 在此研究中，我們發現呼吸器脫離失敗組有較高的BUN、I/O量、MV以及有較低的Albumin，其中8-iso-PGF2α與Albumin呈現顯著負相關性 (ρ = -0.383, p = 0.016)，Albumin作為一個影響呼吸器脫離的因子，氧化壓力是否會經由某些機轉影響到血中Albumin濃度，未來可能還需要更多的研究探討。
Background: Reactive oxygen species (ROS) exert significant influence on contractile function of skeletal muscles of the respiratory system, In human and animals, diaphragmatic inactivity associated with mechanical ventilation leads to muscle fiber atrophy in the diaphragm and to a reduction in diaphragmatic force-generating capacity. Oxidative stress is thought to be a key factor contributing to MV-induced respiratory muscle dysfunction.
Objective: The aim of this study was to determine if differences in blood measures of oxidative stress marker (8-iso-PGF2α) in patients who had success and failure in weaning from mechanical ventilation.
Methods: This was a prospective analysis of MV-dependent patients (?24 h) undergoing a weaning protocol. All patients had been on spontaneous breathing trial through T-piece for 30 min. Clinical data and blood sample were obtained at 5 min before SBT trial. Weaning failure is defined as either the failure of SBT or the need for reintubation within 48 h following extubation.
Result: 28 patients had success weaning and 14 patient had failure weaning. Albumin, BUN, I/O, MV were significantly different between weaning success and weaning failure ; The oxidative stress 8-iso-PGF2α level was not significantly different between weaning success and weaning failure (p = 0.8) ; 8-iso-PGF2α level was significantly correlated to SOFA Score (ρ = 0.421, p = 0.006) and duration of ventilation (ρ = 0.433, p = 0.005) ; 8-iso-PGF2α level was significantly negative correlated to albumin level (ρ = -0.383, p = 0.016).
Conclusions: In this study, we found weaning failure group presented higher BUN, I/O, MV and lower albumin level. Among them, 8-iso-PGF2α level was significantly negative correlated to albumin level. As albumin was a factor of affecting weaning outcomes, whether 8-iso-PGF2α would affect albumin level in some mechanism should be more research in the future. |
