俯卧位和旋转体位治疗实验性急性呼吸窘迫综合征  

Experimental acute respiratory distress syndrome treated by prone and rotation positions

作　　者：戢新平[1] 杨悦[2] 杨丽丽[1] 刘志[1] 

机构地区：[1]中国医科大学附属第一医院急诊科,辽宁沈阳110001 [2]沈阳市铁西区中心医院,辽宁沈阳110000

出　　处：《中国现代医学杂志》2005年第5期687-690,共4页China Journal of Modern Medicine

摘　　要：目的探讨体位变化对急性呼吸窘迫综合征的治疗效果和对呼吸力学、细胞因子的影响以及对循环功能是否有负面作用。方法采用油酸型ARDS兔模型,分为正常对照组(Ⅰ组)、仰卧位油酸组(Ⅱ组)、俯卧位油酸组(Ⅲ组)、旋转体位油酸组(Ⅳ组),观察各组兔实验过程中动脉氧分压、呼吸力学、细胞因子和血压、心率的变化。结果Ⅳ组兔的心率在实验结束时要比Ⅲ组兔低,P<0.05;Ⅲ、Ⅳ组的动脉氧分压、肺的顺应性要比Ⅱ组高,P<0.05;Ⅲ、Ⅳ组肺内分流要比Ⅱ组明显低,P<0.05;Ⅳ组的气道峰压要比Ⅲ组为高,P<0.05;Ⅱ、Ⅳ组兔TNF-α比对照组显著升高,P<0.05,而Ⅲ组和对照组差别无显著性;三个实验组的动脉氧分压与肺的顺应性成明显正相关,与肺内分流成明显负相关。结论俯卧位和旋转体位能改善ARDS肺的顺应性、减少肺内分流,改善氧合;但俯卧位比旋转体位安全并能减少TNF-α的过度分泌。To study the effects of body changes to the lung mechanics, cytokines and circulation of oleic acid-induced ARDS model. The study groups consisted of one control group and three experimental groups that the rabbits were put on supine, prone and rotation, respectively. Then observing the changes of partial pressure of arterial oxygen, lung mechanics, cytokines and blood pressure ,heart rate in the course of experiment. At the end of experiment, heart rate of rotation rabbits was lower than that of prone rabbits, P <0.05; Partial pressure of arterial oxygen and lung compliance of prone and rotation rabbits were higher than that of supine rabbits, P <0.05, but intrapulmonary shunt was just up side down; airway peak inspiration pressure of rotation rabbits was higher than that of prone group rabbits, P <0.05; TNF-α in supine and rotation rabbits was higher than that in control rabbits ,but it wasn′t the case in prone rabbits; Partial pressure of arterial oxygen was positive correlation to lung compliance and negative correlation to intrapulmonary shunt. [Conclusion] Prone and rotation positions can increase lung compliance and decrease intrapulmonary shunt accompanied with oxygenation improving in ARDS model, but prone is safer than rotation position, the former can inhibit the secretion of TNF-α.

关 键 词：急性呼吸窘迫综合征 俯卧位 旋转体位 油酸 兔 

分 类 号：R563.8[医药卫生—呼吸系统]