俯卧位通气对肺内和肺外不同源性急性呼吸窘迫综合征犬外周血和支气管肺泡灌洗液中炎性介质的影响  

Effects of prone position ventilation on inflammatory factors in blood and bronchial alveolar lavage fluid of acute respiratory distress syndrome dogs caused by pulmonary and extrapulmonary insults

作　　者：解立新[1] 刘又宁[1] 赵晓巍[2] 陈良安[1] 黄丽杰[3] 郝凤英[1] 曹璐[1] 

机构地区：[1]解放军总医院呼吸科,北京100853 [2]武警总医院 [3]解放军总医院医学动物实验中心,北京100853

出　　处：《中华医学杂志》2004年第14期1200-1204,共5页National Medical Journal of China

基　　金：国家自然科学基金资助项目 ( 3 0 2 0 0 114 )

摘　　要：目的　观察在俯卧位条件下小潮气 +呼气末正压 (PEEP)通气对急性呼吸窘迫综合征(ARDS)模型犬外周血和肺不同部位 [肺上区 (肺尖叶 )、肺下区腹侧 (肺心叶 )和肺下区背侧 (肺膈叶 ) ]支气管肺泡灌洗液 (BALF)中炎性介质的作用。方法　健康雄性杂种犬 2 4只随机分为肺内源性ARDS实验组、对照组和肺外源性ARDS实验组、对照组 ,每组 6只。采用静脉注射油酸形成肺外源性ARDS动物模型 ,应用十六烷磺基丁二酸钠盐气管内吸入形成肺内源性ARDS动物模型。动态观察俯卧位条件下小潮气 +PEEP对ARDS模型犬氧合指数、外周血和肺不同部位 (肺尖叶、肺心叶和肺膈叶 )BALF中炎性介质 [肿瘤坏死因子 α(TNF α) ,白介素 1β(IL 1β) ,IL 6 ]的作用。 结果　肺损伤后杂种犬氧合指数明显下降 ,外周血炎性介质明显升高 ,肺内源性ARDS动物模型肺尖叶和肺心叶BALF中炎性介质水平明显高于肺外源性ARDS动物模型 ,应用俯卧位 +小潮气 +PEEP通气治疗 ,对肺外源性ARDS动物模型和肺内源性ARDS动物模型均有明显的作用 ,动脉血氧合指数明显改善 ,炎性介质释放受到抑制。结论　肺外源性ARDS和肺内源性ARDS的肺不同部位炎性介质释放具有明显的差异 ,而俯卧位 +小潮气Objective To observe the changes of inflammatory factors in blood and bronchial alveolar lavage fluid (BALF) of different lung areas of acute respiratory distress syndrome (ARDS) dogs caused by pulmonary and extra pulmonary causes with low tidal volume and positive end expiratory pressure (PEEP) treatment under prone position ventilation Methods 24 male mongrel dogs were randomly divided into 4 equal groups:ARDSp (ARDS caused by pulmonary causes) experimental group, ARDSp control group, ARDSexp (ARDS caused by extra pulmonary causes) experimental group, and ARDSexp control group The ARDSp dogs inspired detergent to cause lung injury, and the ARDSexp dogs were injected with oleic acid through central vein The results of TNF α, IL 1β, and IL 6 of blood and BALF in different areas of dog′s lung (upper lobe, heart lobe, and diaphragm lobe) and arterial blood gas under lung protective ventilation treatment were measured Results After lung injury, the arterial oxygenation index as decreased, and the values of TNF α, IL 1β, and IL 6 in plasma were obviously getting higher in all groups The values of inflammatory factors in the BALF from upper lobe and heart lobe of ARDSp dogs were significantly higher than those of the ARDSexp dogs After receiving low tidal volume and PEEP ventilation under prone position, all dogs were gradually getting ameliorated Conclusion There are statistically those of the differences in inflammatory factor releasing in different lung areas between the ARDSp dogs and ARDSexp dogs, and low tidal volume and PEEP treatment under prone position ventilation shows good effects both on ARDSexp dogs and ARDSp dogs

关 键 词：俯卧位通气 不同源性 急性呼吸窘迫综合征 犬 外周血 支气管 肺泡灌洗液 炎性介质 肺通气 潮气量 

分 类 号：R563.8[医药卫生—呼吸系统]