肺表面活性物质和吸入一氧化氮治疗感染性急性肺损伤  

Surfactant and inhaled nitric oxide in treatmont of acute lung injury induced by escherichia coli peritonitis in pigs

作　　者：朱友荣[1] 龚小慧[1] 吕勇[1] 王传清[1] 朱列伟[1] 张灵恩[1] 孙波[1] 

机构地区：[1]复旦大学附属儿科医院呼吸急救实验室,上海200032

出　　处：《中华急诊医学杂志》2004年第10期673-675,i002,共4页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金项目 ( 3 0 170 989);上海市科委优秀学科带头人资助

摘　　要：目的　研究肺表面活性物质 (Surf)和吸入一氧化氮 (iNO)治疗幼猪感染性腹膜炎诱发急性肺损伤 (ALI)的作用及疗效。方法　健康雄性幼猪 (7 5± 0 5 )kg 30只 ,随机分为 5组 ,每组 6只 :正常组 (N组 ) ,对照组 (C组 ) ,吸入一氧化氮组 (NO组 ) ,肺表面活性物质组 (Surf组 ) ,联合应用Surf和吸入NO组 (SNO组 )。正常组腹腔注射无菌生理盐水后 ,单纯机械通气 ;其余动物腹腔注射标准大肠杆菌菌株诱发ALI后再随机分为四组进行治疗。监测血气 ,呼吸力学 ,支气管肺泡灌洗液 (BALF)成分分析和肺病理改变。结果　腹腔注射大肠杆菌后 4～ 6h动物出现ALI,C组动脉血氧合 (PaO2 /FiO2 )和呼吸系统动态顺应性 (Cdyn)显著性下降 ,治疗后SNO组有较高的PaO2 /FiO2 和Cdyn (与C组比较P <0 0 1) ,肺组织病理损害较轻 ;与SNO组相比 ,单独应用Surf效果稍差 ;NO组对Cdyn肺组织病理损害改善不明显。结论　联合应用Surf和吸入NO能明显改善氧合、肺功能 ,减轻肺病理损害 。Objective To investigate efficacy of prophylactic surfactant and inhaled nitric oxide(iNO) in alleviating the acute lung injury. Methods Thirty piglets (body weight 6 to 9 kg) were randomly allocated to either a negative control group (group N, n=6) with only normal saline and groups with escherichia coli (n=6 each) followed by treatment with: (1)a positive control with mechanical ventilation only (group C),(2) iNO at 10 ppm (group NO),(3) surfactantat 100 rog/kg (group Surf),(4) both surfactant and iNO the same as in groups of NO and Surf (group SNO). Arterial blood gas, dynamic lung compliance (Cdyn) were measured every 12 h. At the end, the lungs were used for biochemical and histopathological analysis. Results Group SNO had the highest PaO 2/FiO 2 and Cdyn values.Values for PaO 2/FiO 2, Cdyn and Rrs in group NO were similar to those in the group C. Both biochemical analysis of bronchoalveolar lavage fluid and morphological measurement supported that SNO had the best effects in lung protection in contrast to NO that had only transient effect on oxygenation. Conclusion The combination of Surf and iNO treatment can alleviate piglet ALI induced by Escherichia coli peritonitis, reflected by improved oxygenation, lung mechanics, alveolar expansion,and permeability.

关 键 词：治疗 吸入 肺表面活性物质 一氧化氮 病理损害 ALI 急性肺损伤 感染性 幼猪 腹腔注射 

分 类 号：R563.8[医药卫生—呼吸系统]