Objective:To investigate the influence of high frequency oscillatory ventilation combined with ulinastatin on serum inflammatory factors, blood gas indexes and endothelial function in patients with respiratory distress after smoke inhalation lung injury.Methods:Sixty-two patients with acute respiratory distress syndrome induced by smoke inhalation lung injury from January 2016 to January 2019 in the 910th Hospital of the PLA Joint Service Support Unit were enrolled.With a prospective cohort study, the patients were divided into control group (31 cases) and observation group (31 cases) according to the random number table.The control group were treated with high-frequency oscillatory ventilation.The observation group was given intravenous ulinastatin treatment on the basis of the control group, 3×105 U/time, dissolved in 50 ml of normal saline, once every 8 hours.Acute physiology and chronic health evaluation (APACHE) Ⅱ score was performed before intervention and 48 hours after intervention.Serum interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α(TNF-α), nitric oxide, endothelin-1 were detected by enzyme-linked immunosorbent assay. Arterial blood oxygen partial pressure (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2), oxygenation index were measured by blood gas analyzer. The Extra-vascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI) were recorded by pulse indicator continuous cardiac output monitoring.The occurrence of adverse reactions were recorded. Results:The IL-6 ((66.8±15.2) ng/L), IL-8 ((70.3±10.4) ng/L, TNF-α ((24.6±3.5) ng/L) of the observation group after treatment 48 hours were lower than before treatment ((89.3±21.0) ng/L, (288.4±33.5) ng/L, (101.3±9.0) ng/L), the difference was statistically significant(t value was 5.704, 21.215, 30.281, repectively, all P<0.05), and the observation group were significantly lower than the control group((90.4±22.4) ng/L, (162.4±16.6) ng/L, (62.3±4.4) ng/L), the difference was statistically significant(t value was 4.906, 12.324, 19.252, repectively, all P<0.05). After 48 h of intervention in the control group and the observation group after 48 h of intervention, the oxygenation index ((208.5±55.4) mmHg and (315.3±49.8) mmHg), PaO 2 ((101.6±12.4) mmHg and (118.8±10.3) mmHg) of the control group and the observation group after 48 hours of intervention were significantly higher than before intervention((114.8±24.6) mmHg and(112.3±20.5) mmHg, (70.6±10.5) mmHg and(70.3±10.2) mmHg)(t value was 15.663 and 22.387, 11.216 and 16.214, repectively, all P<0.05, the PaCO 2 ((44.7±7.4) mmHg and (39.3±4.8) mmHg), EVLWI ((12.42±3.66) ml/kg and (9.70±2.33) ml/kg), PVPI (2.34±0.48 and 1.82±0.35) significantly lower than before intervention((47.8±5.6) mmHg and(48.3±6.5) mmHg, (16.58±4.05) ml/kg and (16.60±4.10) ml/kg, 2.86±0.55 and 2.90±0.53), ( t value was 3.655 and 7.372, 3.516 and 6.521, 3.571 and 8.024, repectively, all P<0.05), the oxygenation index , PaO 2 in the observation group after intervention were significantly higher than those in the control group, P<0.05, while PaCO 2, EVLWI and PVPI in the observation group were significantly lower than the control group, t value was 7.106, 4.213, 4.037, 7.122, 3.976, repectively, all P<0.05.The nitric oxide((76.65±30.25) μmol/L and (54.15±20.36) μmol/L), endothelin ((58.32±20.26) ng/L and (42.23±21.15) ng/L), APACHE Ⅱ score ((10.05±2.84) points and (7.14±2.74) points) of the control group and the observation group after 48 h intervention were significantly lower than before intervention ((90.30±33.33) μmol/L and(89.62±34.64) μmol/L, (71.64±28.35)ng/L and (70.36±26.56)ng/L, (23.46±4.13)points and(23.60±4.20)points), ( t value was 3.761 and 8.063, 4.031 and 7.376, 6.193 and 11.531, repectively, all P<0.05). The nitric oxide, The endothelin and APACHE Ⅱ scores in observation group after 48 h intervention were significantly lower than those of the control group ( t value was 3.759, 3.515, 3.715, repectively, all P<0.05). There were no adverse drug reactions occurred during the treatment in both groups. Conclusion:High frequency oscillatory ventilation combined with ulinastatin in the treatment of respiratory distress after smoke inhalation lung injury can inhibit the excessive release of inflammatory mediators and improve vascular endothelial function, thereby reducing capillary leakage, reducing EVLWI and increasing oxygenation index.

Objective:To explore the performance of the commonly used whole blood C-reactive protein (CRP) detection systems and give related recommendation on the performance requirements of detection systems.Methods:A total of 7 540 venous blood samples from 26 maternal, child and children′s hospitals were collected to conduct this multi-center study on the analytical performance of 5 commonly used whole blood CRP detection systems from March to April in 2019. The blank check, carryover, repeatability, intermediate precision, linearity, sample stability, influence of hematocrit/triglyceride/bilirubin, comparison with SIEMENS specific protein analyzer and trueness were evaluated. The 5 systems included BC-5390CRP autohematology analyzer, AstepPLUS specific protein analyzer, Ottoman-1000 Automated Specific Protein POCT Workstation, i-CHROMA Immunofluorometer equipment Reader and Orion QuikRead go detecting instrument. The 5 systems were labeled as a, b, c, d and e randomly.Results:Within the 5 systems, all values of blank check were less than 1.00 mg/L, the carryovers were lower than 1.00%. The repeatability of different ranges of CRP concentrations including 3.00-10.00, 10.00-30.00 and>30.00 mg/L were less than 10.00%, 6.00% and 5.00%, respectively, and the intermediate precision was less than 10.00%. The linearity correlation coefficients of the 5 systems were all above 0.975, while the slope was within 0.950-1.050. Whole blood samples were stable within 72 hours both at room temperature (18-25 ℃) and refrigerated temperature (2-8 ℃). The CRP results were rarely influenced by high triglyceride or bilirubin, except for the immmunoturbidimetric test based on microparticles coated with anti-human CRP F(ab) 2 fragments. When triglyceride was less than 15.46 mmol/L, the deviation of CRP was less than 10.00%. When bilirubin was less than 345.47 μmol/L, the deviation of CRP was less than 10.00%. CRP was more susceptible to Hct on the systems without Hct correction. The deviation of CRP between different Hct dilution concentration and 40% dilution concentration can reach as high as 67.48%. The correlation coefficients ( r) of 5 systems were all more than 0.975 in the range of 0-300.00 mg/L compared with Siemens specific protein analyzer. All systems passed the trueness verification using the samples with specified values of 12.89 and 30.60 mg/L. Conclusion:The performance of 5 systems can basically meet the clinical needs, but it is suggested that the whole blood CRP detection system without automatic Hct correction should be modified manually.