雾化吸入前列环素治疗犬油酸型ARDS  

Effects of inhaled aerosolized prostacyclin on oleic acid-induced acute respiratory distress syndrome in canines

作　　者：刘志武 孙运波[2] 

机构地区：[1]107医院麻醉科,山东烟台264002 [2]青岛大学附属医院 ICU,山东青岛266071

出　　处：《实用医药杂志》2007年第3期333-336,共4页Practical Journal of Medicine & Pharmacy

摘　　要：目的探索雾化吸入前列环素(PGI_2)对油酸型ARDS犬的治疗作用及量效关系。方法13只杂种犬麻醉后机械通气,经颈外静脉置入Swan-Ganz导管,经颈静脉注射油酸,PaO_2/FiO_2≤200mmHg为ARDS模型建立成功。随机分为对照组(n=5)与雾化吸入PGI_2(IAP)组(n=8)。对照组单纯行机械通气治疗; IAP组以0、5、10、20、30、50、100ng/kg·min雾化吸入PGI_2 15min,间隔15min。观察血流动力学指标,血气、肺动态顺应性(Cdyn)等变化,并计算氧合指数(PaO_2/FiO_2)与肺内分流率(Qs/Qt),实验结束后行肺病理检查,测定肺水含量。结果PaO_2在IAP 50和100ng/kg·min时明显提高(P＜0．05);而PaCO_2在各剂量治疗前后无明显变化(P＞0．05)。Qs/Qt在IAP 20～100ng/kg·min明显降低(P＜0．05),且随剂量增加降低似更明显。体循环血流动力学参数(MAP、HR、CI、CVP)无明显变化(P＞0．05),而PAP在10～100ng/kg·min均明显降低(P＜0．05),PVR在20～100ng/kg·min剂量均降低明显。各剂量治疗前后cdyn无明显变化(P＞0．05)。IAP组肺水含量明显低于对照组(P＜0．05),且肺组织炎症变化也低于对照组。结论雾化吸入PGI_2是一种有效的选择性扩张肺血管方法,在10～100ng/kg·min可呈剂量依赖性的对ARDS治疗作用。Objective To determine the efficacy of dose- response relationships to inhaled aerosolized prostacyclin（IAP） in canines with oleic acid-induced acute respiratory distress syndrome（ARDS）.Method The models of ARDS which was regarded successfully when PaO2/FiO2 was no more than 200mmHg were reproduced by intravenous injection of oleic acid in 13 canines. The ARDS canines were randomly assigned to control group （n=5） and IAP group （n=8）.Animals in the control group were only mechanically ventilated, while animals in the IAP group received IAP 0,5,10,20,30,50,100ng/kg.min with each dosage for 15 minutes and each interval of 15 minutes. Hemodynamic parameter, the arterial and mixed venous blood gas, pulmonary dynamic compliance （Cdyn） and shunt fraction（Qs/Qt） were measured or calculated just before and after the each IAP dosage. The pulmonary pathology, lung water were assessed at the end of the experiment. Results PaO2 increased markedly from 50 to 100ng/kg.min （P〈 0.05） while PaCO2 didn＇t indicate significant variation at each dosage. The Qs/Qt decreased markedly during IAP from 20 to 100ng/kg·min（P〈0.05） with the increase of IAP dosage. Hemodynamic parameters of systemic circulation including MAP, HR. CVP, PCWP, CO, CI and SVR did not indicate any significant difference （P〉0.05） at any IAP dose. However, the PAP decreased markedly during IAP from 10 to 100ng/kg.min （P〈0.05） and the PVR decreased significantly during IAP from 20 to 100ng/kg.min （P〈0.05）. There was no significant change （P〉0.05） in Cdyn at any dose between before and after IAP. Lung water was lower than in control group （P〈0.05） and the pulmonary inflammatory response in IAP group also less significantly than that in control group.Conclusion IAP, an effective selective pulmonary. vasodilator, could be a therapeutic programmers for ARDS at the dose from 10 to 100ng/kg.min.

关 键 词：前列环素 ARDS 雾化吸入前列环素 

分 类 号：R563.8[医药卫生—呼吸系统] R-332[医药卫生—内科学]