部分液体通气对急性肺损伤兔肺表面活性物质的影响  

Effect of partial liquid ventilation on pulmonary surfactant during acute lung injury in rabbits

作　　者：孙震[1] 吕晶[1] 陈卫民[1] 张秉钧[1] 

机构地区：[1]中国医科大学附属第二医院麻醉科,沈阳市110004

出　　处：《中华麻醉学杂志》2004年第5期369-372,共4页Chinese Journal of Anesthesiology

摘　　要：目的 研究部分液体通气(PLV)对油酸诱导的急性肺损伤肺表面活性物质的影响。方法 24只健康成年日本大白兔随机分成三组,每组8只:正常对照单纯机械通气组(C组);油酸肺损伤机械通气组(MV组)和油酸肺损伤部分液体通气组(PLV组)。中心静脉滴注油酸150μg/kg诱导急性肺损伤(ALI)模型,1h后当PaO_2/FiO_2<300时,认为造模成功,再连续通气4h,用多导生理监测仪连续记录血压和心率的变化,并测定基础、肺损伤及治疗后1、2、4h动脉血气。治疗4h立即处死动物,描记肺的压力-容积曲线,行右肺支气管灌洗,测量灌洗液中双饱和磷脂酰胆碱(DPPC)、肺表面活性物质相关蛋白A(SP-A)、总蛋白(TP)的浓度。结果 PLC组经PLV治疗后,PaO_2提高(P<0.01),各时段PaO_2高于MV组(P<0.01);PLV组PaCO_2逐渐降低,治疗后4h,PaCO_2与MV组差异有显著性(P<0.05)。PLV组灌洗液中DPPC、SP-A的含量高于MV组(P<0.01),而TP的含量低于MV组(P<0.01)。PLV组肺的顺应性较MV组提高。结论 PLV可增加油酸性急性肺损伤肺泡Ⅱ型上皮细胞分泌肺泡表面活性物质,改善肺功能。Objective To investigate the effect of partial liquid ventilation(PLV) with perfluorocarbon (PFC) on pulmonary surfactant during beatment of acute lung injury(ALI) induced by oleic acid. Methods Twenty-four male Japanese white rabbits weighing 2. 1-2.6 kg were randomly divided into three groups(n = 8 in each group): groupl: normal animal + mechanical ventilation (MV); group 2: ALI + MV; group 3: ALI + PLV.The animals were anesthetized with intraperitoneal ketamine 100 mg/kg, trachectomized and mechanically ventilated (FiO_2 = 1, RR = 35 bpm, I: E = 1: 2, PEEP = 5 cm H_2O, PaCO_2 was maintained at 35-45 mm Hg by adjustment of tidal volume) .In group 2 and 3 ALI was induced by infusion of oleic acid 150μg/kg via central venous catheter over 30 min period. ALI was considered established when PaO_2 /FiO_2 was<300. In group 3 PFC 18 ml/kg was instilled into the lung via endotracheal tube over 10 min and additional 8 ml of PFC was given every hour to compensate for the loss by its volatility. Blood samples were obtained for blood gas analysis before induction of ALI(To, baseline), after ALI was established(T_1) and at 1,2,4 h after PLV was started(T_(2,3,4)). BP and HR were continuously monitored during experiment. The animals were killed at the end of experiment. Static lung compliance was measured and pressure-volume curve constructed. Right lung was lavaged with normal saline 10 ml/ kg three times and broncho-alveolar lavage fluid (BALF) was collected for RBC, poly-morphonuclear and macrophage counts and determination of surfactant-protein A (SPA), dipalmitoyl-phosphatidyl-choline (DPPC ) and total protein concentrations. Results In group 3 (PLV group) PaO_2 increased significantly after institution of PLV(P<0.01 ). PaO_2 was significantly higher in group 3 than that in group 2 at all time points afer treatment (T_(2,3,4)) (P<0. 01). PaCO_2 was gradually reduced in

关 键 词：液体通气 急性肺损伤 兔 肺表面活性物质 PLV 呼吸窘迫综合征 

分 类 号：R563.8[医药卫生—呼吸系统]