机械通气对急性肺损伤兔肺水肿影响的实验研究  

Effect of Mechanical Ventilation on Lung Edema in Rabbits with Endotoxin-induced Acute Lung Injury

作　　者：秦志强[1] 王辰[2] 庞宝森[2] 孙兵[2] 杜敏捷[2] 牛淑杰[2] 龙胜泽[1] 

机构地区：[1]广西壮族自治区人民医院呼吸内科 [2]首都医科大学附属北京朝阳医院北京呼吸疾病研究所

出　　处：《首都医科大学学报》2007年第5期575-578,共4页Journal of Capital Medical University

基　　金：广西壮族自治区科技厅自然科学基金(桂科自0542066)资助项目~~

摘　　要：目的研究不同潮气量联合不同水平呼气末正压(PEEP)机械通气对急性肺损伤(ALI)兔肺水肿的影响。方法用数字表法将36只新西兰兔随机分为正常对照(NC)组、ALI组、常规潮气量(15mL/kg)低PEEP(5cmH2O)(CVLP)组、常规潮气量高PEEP(10cmH2O)(CVHP)组、小潮气量(8mL/kg)低PEEP(LVLP)组和小潮气量高PEEP组(LVHP组)。以内毒素静脉注射建立ALI动物模型,经机械通气的4组动物分别给予不同潮气量联合不同水平PEEP机械通气4h。实验结束后取肺组织测定湿质量/干质量比值评价肺水肿严重程度。结果NC组、ALI组、CVLP组、CVHP组、LVLP组和LVHP组的肺湿质量/干质量比值分别为4.81±0.19、5.84±0.20、5.47±0.28、5.25±0.12、5.24±0.12和5.12±0.10,NC组低于其他各组,差异有统计学意义(P<0.05);ALI组高于各机械通气组,差异有统计学意义(P<0.05);LVHP组低于CVLP组,差异亦有统计学意义(P<0.05)。结论机械通气能够减轻ALI肺水肿,小潮气量联合高PEEP机械通气减轻ALI肺水肿的作用更加显著。Objective To investigate the effects of mechanical ventilation with different tidal volumes （VT） and positive end- expiratory pressure（PEEPs） on the lung edema in acute lung injury rabbit（ALl） models. Methods Thirty-six New Zealand rabbits were randomized into 6 groups （ 6 in each group）. ①normal control group （ NC）, ② ALl group （ Lipopolysaccharides 50 μg/kg intravenously）, ③CVLP group（ALI ＋ ventilation with VT 15 mL/kg and 5 cmH2O PEEP）, ④ CVHP group（ALI ＋ ventilation with VT 15 mL/kg and 10 cmH2O PEEP）, ⑤ LVLP group（ ALI＋ ventilation with VT 8 mL/kg and 5 cmH2O PEEP）, ⑥LVHP group（ ALl ＋ ventilation with VT 8 mL/kg and 10 cmH2O PEEP）. The ALI models receiving ventilation with different tidal volumes and PEEPs were ventilated for 4 h. Lung wet-to-dry weight（W/D） ratio was used to assay the lung edema. Results The W/D ratios in CVLP group（5.47 ± 0.28）, CVHP group （5.25 ± 0.12）, LVLP group （ 5.24 ± 0.12） and LVHP group （ 5.12 ± 0.10） decreased significantly （ P 〈 0.05 ） as compared with that of the ALl group （5.84 ± 0.20）, but increased（ P 〈 0.05 ） as compared with the NC group（4.81 ± 0.19 ）. The W/D in LVHP group was lower than that in CVLP group （P 〈 0.05）. Conclusion Ventilation attenuates lung edema in ALI models. Ventilation with both low VT and high PEEP is more beneficial for lung edema in ALI.

关 键 词：急性肺损伤 机械通气 肺水肿 

分 类 号：R563.4[医药卫生—呼吸系统]