Application Research Of Detecting SuPAR,RAGE, PCT And CRP Levels In Acute Respiratory Distress Syndrome Patients With Ventilator Bundle

ObjectiveBy detecting the levels of plasma/serum soluble urokinase plasminogen activator receptor (suPAR), receptor of advanced glycation end products (RAGE), procalcitonin (PCT) and c-reactive protein (CRP), to investigate the prognosis of ventilator bundle in patients with acute respiratory distress syndrome (ARDS).MethodsA total of54cases of ARDS patients were selected in our research, who were received treatment of invasive mechanical ventilation in our hospital intensive care unit (ICU) between January2013and December2013. All of the patients were given ventilator bundle, including,①elevation of the head of the bed to30-45°.②daily interruption of sedation and spontaneous breathing Test (SBT).③gastric ulcer prophylaxisr.④deep vein thrombosis (DVT) prophylaxis.⑤oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions(CASS). These patients were divided into two groups according to the situation of the implementation (dependence), VB group achieved all application of ventilator bundle measures(n=29), and NVB group did not reach all the application of ventilator bundle measures(n=25). Compare the mechanical ventilation time, ICU length of hospital stay, the incidence rate of ventilator associated pneumonia (VAP), the incidence rate of other complications and mortality rate of28days between the two groups of patients. Detect the plasma/serum suPAR, RAGE, PCT and CRP level before and after treatment, and compare the changes and differences.Results①There was no significant difference in ratio of sex, mean age, acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score and oxygenation index (PaO2/FiO2), as to as other basic state between two groups (P＞0.05).②Correlation analysis:Age is negatively related to the PaO2/FiO2(P＜0.05). PaO2/FiO2was negative correlation with suPAR, RAGE, PCT and CRP (P＜0.01or P＜0.05). Plasma suPAR, PAGE, PCT levels were positive correlation (P＜0.01). Mechanical ventilation time and ICU length of hospital stay were positive correlation(P＜0.01).③There was no obvious difference of plasma/serum suPAR, RAGE, PCT and CRP levels between two groups before treatment. The levels of these markers were decreased after treatment.④Compared with before treatment, the plasma/serum suPAR, RAGE, PCT and CRP levels decreased after treatment in two groups of patients, the difference was statistically significant (P<0.01).⑤The plasma suPAR and RAGE levels in VB group decreased significantly compared with NVB group, the difference was statistically significant (P＜0.01). The decline of PCT and CRP levels was no obvious difference after treatment.⑥VB group of patients with mechanical ventilation time, ICU length of hospital stay and the incidence of VAP were lower than those of NVB group, the difference was statistically significant (P＜0.05). The mortality rate of28days and other related complication rates were no significant difference between the two groups.Conclusion①Plasma/serum suPAR, RAGE, PCT and CRP levels were associated with the severity of ARDS patients.②The ventilator bundle can affect the plasma/serum suPAR, RAGE, PCT and CRP levels, thereby reducing inflammatory reaction and improving the prognosis of patients with ARDS.③The ventilator bundle can significantly decrease the incidence of VAP, reduce the mechanical ventilation time and ICU length of hospital stay, have a positive impact on prognosis of ARDS patients.④Compliance of ventilator bundle can affect the prognosis of patients with ARDS, the high compliance of patients remain lower complication rate and mortality.