A Clinical Study On The Lung’s Protective Effects Of Perfluorocarbon On Smoke Inhalation Injury

BackgroundAt present, smoke inhalation injury with high fatality has no special treatment. It has been proved that perfluorocarbon(PFC) can obviously improve the lung and systemic inflammatory response, oxygenation of lung on the smoke inhalation injury in animal models.ObjectiveThe study is to observe the the treatment outcome,pulmonary oxygenation and inflammatory factor associated of burns complicated moderately severe smoke inhalation injury patients between conventional treatment and PFC treament.To discuss the lung protective effect of PFC and to provide support for further clinical application.Methods1.Burns complicated moderately/severe smoke inhalation injury patients were randomly divided into test or control group.Patients in control group received anti-infection therapy, nutritional support, anti-shock measures and supportive treatment, and so on. Patients in test group received the same treatment as the control group, and injecting into the15ml PFC through endotracheal every12hours for3days.2.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were measured of all the involved patients at admission and at time of3days after treatment. Blood gas analysis was also detectived to observe the oxygenation index(OI),the alveolar-arterial oxygen tension gradient(P(A-a)O2) and lung dynamic compliance (Cdyn) before treatment and at time of3days after treatment. Patients underwent bronchoalveolar lavage before treatment and at time of3days after treatment. Then the bronchoalveolar lavage fluid(BALF) as centrifugated and was stored in vessel at-80℃. The differential counts of the precipitation of BALF was detected immediately.The blood samples was obtained and was centrifugated before treatment and at time of3days after treatment.The supernatant was stored in vessel at-80℃. The inflammatory factors of TNF-α、IL-8、NF-κB in the plasma and the supernatant of BALF were detected by ELISA.Results1.12patients who were burns complicated moderately severe smoke inhalation injury were divided into test group and11patients were divided into control group. After treatment, the APACHE II scores of the test group declined(P<0.05).2. Although OI of test group had increased, there was no significantly different from that of the test group(P>0.05).The P(A-a)O2and Cdyn of the two groups all decreased after the3-days’treatment.But the P(A-a)O2and Cdyn of the test group were better than those of the control group(P<0.05).3. After the3-days’ treatment,the proportion of neutrophils in the BALF of the two groups both declined,the proportion of macrophages in the BALF of the two groups both increased. After treatment, the proportion of neutrophils in the BALF of the patients in the test group reduced significantly(P<0.01),and the proportion of macrophages in the BALF of the patients in the test group increased significantly(P<0.05).There was significant difference in the proportion of neutrophils(P<0.01) and macrophages(P<0.05) in the BALF between the two groups.4. The level of TNF-a in BALF of the test group declined but was not significantly different from that of the control group(P>0.05).After treatment,the levels of IL-8(P<0.05) and NF-κB(P<0.05) in BALF of the test group declined significantly (P>0.05).5.There was no difference in the level of TNF-α、IL-8and NF-κB in plasma of two groups. Conclusion1.Injecting into the PFC through endotracheal improve P(A-a)O2and Cdyn of smoke inhalation injury patient markly,and improve gas exchange.2.Injecting into the PFC through endotracheal can reduce the lung infiltration of neutrophil and increase the number of macrophages to promote the absorption and plays a protective role in early lung injury.3.Injecting into the PFC through endotracheal can reduce the release of inflammatory cytokines in lung tissue,such as IL-8、NF-κB, and play a anti-inflammatory effects.