肺表面活性物质-呼气末正压治疗血浆诱导的急性呼吸窘迫综合征  

Surfactant-positive end-expiratory pressure treatment for adult rats with ARDS induced by plasma

作　　者：王菲[1] 甘小庄[1] 宋国维[1] 孙丽萍[1] 马广松[1] 

机构地区：[1]首都儿科研究所急诊科,北京100020

出　　处：《中国医刊》2007年第4期35-38,共4页Chinese Journal of Medicine

基　　金：国家科技部攻关项目(2003BA712A11-10)

摘　　要：目的 研究在急性呼吸窘迫综合征（ARDS）时，联合应用肺表面活性物质（PS）和呼气末正压（PEEP）治疗的效果，并探讨两者之间的关系。方法 45只健康SD大鼠，体重为200～312g，麻醉后进行机械通气，气管内滴注血浆至PaO2〈200mmHg，将实验动物随机分为PEEP4.0（4cmH2O）和PEEP7．5（7．5cmH2O）条件下对照组、PS100（100mg／kg）组和PS200（200mg／kg）组共6组，分别在滴注血浆前、急性肺损伤制成后、给药后30、60、90、120、150和180分钟测定大鼠血气分析、静态比胸肺顺应性（Cst）。实验后取左肺用于病理检查和计算肺指数（LI）。结果 经过血浆滴注后，各组实验动物PaO2和Cst分别下降到79．8±19．8mmHg和0．42±0．07ml／（cmH2O·kg）。PEEP7.5 PS200组和PS100组的PaO2回升至383±57mmHg和398±51mmHg，明显高于其他4组（P〈0．01），此两组比较，PaO2无显著差别。PEEP7.5水平下的3个组，PaO2和LI均显著高于PEEP7.5各对应组（P〈0．05）。PEEP7.5 PS100组和PS200组大鼠肺透明膜形成显著少于其他四组（P〈0．05），PEEP7．5 PS100组肺透明膜形成显著少于PEEP4.0 PS200组（P〈0．05）。结论 在滴注血浆诱导的大鼠ARDS时，高剂量PS较低剂量PS能更有效对抗血浆蛋白的抑制作用；使用合适的较高PEEP与低剂量PS联合治疗能有效改善肺氧合功能和胸肺顺应性，并节省PS用量。Objective This study was designed to evaluate the efficacy of PS in different concentration with PEEP in different level on adult rats with acute respiratory distress syndrome （ARDS） induced by plasma. Methods Male Sprague-Dawley rats were performed by repeated lung-instillation with human plasma. Then the animals were randomly assigned to PEEP4.0（4 cmH2O） and PEEPT.5 （7.5 cmH2O） groups, receiving intratracheally air, Curosurf （100mg/kg） and Curosurf （200mg/kg） respectively for PEEP4.0/PEEP7.5 control, PS100 and PS200 groups. The blood gas analyses and static lung-thorax compliance （ Cst ） were measured before plasma instillation and 30,60,90, 120,150 and 180min post-treatment. At the end, the lung index （LI） and histopathological examinations were performed. Results The PaO2 and Cst of all animals were 485.6 ± 17.5mmHg and 1.37 ± 0.24 ml/（ cmH20 · kg） during the baseline period, and decreased to 79.8 ±19.8mmHg and 0.42 ±0.07ml/（ cmH20 · kg） respectively （P 〈0.001 ）. The PaO2 in the PEEP7.5 PS100 and PS200 groups increased to 398 ±51mmHg and 383 ±57mmHg （P 〈0.01 vs. the other four groups） 30 min after the administration, respectively. PaO2 and LI in every group of PEEP7.5 were better than the corresponding groups of PEEP4.0. The PEEP7.5 PS100 and PS200 animals had much fewer hyaline membrane formation compared with the other four groups （ P 〈 0.05 ）. Conclusion The data suggests higher concentrations of PS are required to overcome the inhibitory effect of plasma protein compared with low concentrations, and using proper higher level of PEEP can improve oxygenation function and reduce protein leakage in rats with ARDS induced by plasma. Treatment of higher PEEP combined with fewer PS can improve lung function and reduce surfactant dose.

关 键 词：肺表面活性物质 呼气末正压 急性呼吸窘迫综合征 血浆 

分 类 号：R725[医药卫生—儿科]