Effect and mechanism of high dose methylprednisolone combined with protective ventilation on traumatic acute respiratory distress syndrome
SHAN Shi-min
WANG Peng
HAO Wei
REN Li-jie
ZHANG Jun
WANG Zhi-song
Abstract：Objective To observe the efficacy of high dose methylprednisolone combined with protective ventilation on traumatic acute respiratory distress syndrome ( ARDS) and to investigate the mechanism .Methods Sixty patients with se-vere traumatic ARDS were randomly divided into two groups , 30 cases in each group:traditional tidal volume group ( group A, VT 10-15 mL/kg) and protective ventilation group (group B, LVT 4-6 mL/kg +positive end expiratory pressure 5-12 cmH2 O +methylprednisolone 5 mg/kg/h) .Recording the hemodynamics index and conducting the blood gas analysis at the time of entering operation-room ( T0 ) and treatment for 1 hour ( T1 ) and treatment for 3 hour ( T2 ) in the two groups . Bronchoalveolar lavage fluid ( BALF) was extracted to measure MDA , NO, inducible nitric oxide synthase ( iNOS) , super-oxide dismutase (SOD) and myeloperoxidase (MPO).Meanwhile, the expression of bone morphogenetic protein-2 (BMP-2) was detected.Results Compared with T0, SBP, cardiac output, cardiac index, left ventricular function and left ven-tricular work indexes were significantly increased , while HR, peripheral vascular resistance , peripheral vascular resistance index decreased significantly , and the changes in group B was more significantly than in group A , all P<0.05;compared with T0, the oxygenation index, pH, SpO2 increased, but lactic acid and PCO2 decreased;compared with group A, the in-dex of oxygenation, SpO2 and lactic acid changes more significantly in group B (all P<0.05).However, MDA, NO, iN-OS, MPO and BMP-2 mRNA and protein expression were higher in group A at T 1 and T2 than those in group B ( all P<0.01).Conclusion High-dose methylprednisolone combined with protective ventilation can significantly change the he -modynamics and blood gas index in the treatment of severe traumatic ARDS , whose mechanism may be related to up-regula-tion of BMP-2 gene and inhibition of lung oxidative damage .
Keywords：acute respiratory distress syndromemethylprednisolonemechanical ventilationhemodynamicsoxygen free radicalbone morphogenetic protein-2
Publication Date：2014-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 19-22 )