部分液体通气对猪急性肺损伤的影响  

Effects of partial liquid ventilation on acute lung injury in piglets

作　　者：孙婵[1] 颜亮[2] 蒋光愉[3] 王仲红[1] 彭雪梅[1] 谷继[4] 邹鹏[1] 李经华[2] 

机构地区：[1]暨南大学第一附属医院麻醉科,广东广州510630 [2]暨南大学第一附属医院医学院病理生理学教研室,广东广州510630 [3]暨南大学第一附属医院病理科,广东广州510630 [4]暨南大学第一附属医院胸外科,广东广州510630

出　　处：《中国病理生理杂志》2004年第6期1070-1073,共4页Chinese Journal of Pathophysiology

基　　金：广东省卫生厅资助项目(A2002319);广东省科委资助项目;粤科基办[2002]4号021178;暨南大学SARS专项基金资助项目;广东省卫生厅资助项目(A2003388);暨南大学青年基金资助项目

摘　　要：目的 :在肺灌洗诱导的急性肺损伤 (ALI)家猪实施以氟碳 (PFC)为媒介的部分液体通气 (PLV) ,观察其对肺气体交换及血液动力学的影响 ,并比较PLV及气体通气两种方式对肺形态学的影响 ,以探讨PLV改善肺气体交换的机制。方法 :12头体重为 2 5 - 30kg的健康雌猪 ,麻醉后经肺灌洗建立ALI模型。随机分为PLV组及CV(气体通气组 )。对照组以呼吸机行常规机械通气 ,PLV组动物经气管导管肺内灌以 15mL/kg的PFC ,然后以与对照组同样的呼吸参数行机械通气。每小时记录肺气体交换及血液动力学参数的变化。于实验结束后处死动物 ,取肺标本送病理分析。结果 :PLV组肺气体交换明显改善 ,而血液动力学在整个实验过程中基本维持稳定。组织学检查 :光学显微镜下可见两组均为肺不张、肺气肿及肺过度膨胀交替出现 ,肺泡间质因水肿及细胞渗出而扩展。PLV组与CV组比较显示较轻微的肺不张、肺内炎性细胞渗出、肺出血及肺间质扩张。PLV组动物腹侧肺组织学损伤改变明显较背侧轻微。结论 :在肺灌洗诱导的急性肺损伤幼猪 ,以氟碳为媒介的部分液体通气可明显地改善肺气体交换 ,并无明显的血液动力学损伤。同时可见PLV相对于对照组明显减轻的肺组织学损伤及肺泡扩张 ,证实PLV具一定的肺保护作用。AIM: To observe the effect of partial liquid ventilation with perfluorocarbon on gas exchange, hemodynamics and lung histological change in the piglets with surfactant depletion-induced acute lung injury. METHODS: 12 piglets were treated by lung lavage to a partial pressure of oxygen in arterial blood (PaO 2) below 100 mmHg for one hour and randomly divided into gas ventilation group (control group) and partial liquid ventilation (PLV) group, in PLV group, piglets received PFC (FC3280) intratracheally at doses of 15 mL/kg. The parameters of gas exchange and hemodynamics were measured before lung lavage, after lung lavage when the acute lung injury (ALI) was established, and 1 hour, 2 hours after ALI. Animals underwent euthanasia at the end of the study, lung histologic analysis followed. RESULTS: Surfactant depletion by lung lavage induced a stable acute lung injury.Gas exchange increased markedly in the animals that underwent PLV, less hemodynamic damage was observed in PLV group compared with the animals in GV group. Lung histologic analysis demonstrated a less lung damage, including atelectasis, neutrophil excudation, intra-alveolar hemorrhage and interstitial edema in PLV group compared with control group. CONCLUSION: In piglets with surfactant depletion-induced acute lung injury, partial liquid ventilation with perfluorocarbon can improve the gas exchange with less adverse hemodynamic effect and less lung injury compared with conventional gas ventilation.

关 键 词：呼吸窘迫综合征 成人 氟碳化合物 液体通气 

分 类 号：R363[医药卫生—病理学]