部分液体通气对胎粪性急性肺损伤的病理学影响  

Pathological change of partial liquid ventilation in a rabbit mecouiurn aspiration lung injury model

作　　者：朱晓东[1] 陈菲[1] 嵇若旭[1] 狄华[1] 谢利娟[1] 朱建幸[1] 

机构地区：[1]上海交通大学医学院附属新华医院儿内科,200092

出　　处：《中华儿科杂志》2008年第10期774-778,共5页Chinese Journal of Pediatrics

基　　金：上海市高等学校青年科学基金项目（02BQ29） 感谢上海交通大学医学院附属上海儿童医学中心病理科张忠德主任,儿内科沈艺医师对本课题的支持.

摘　　要：目的通过研究部分液体通气（PLV）对胎粪性急性肺损伤病理学变化的影响，探讨PLV对治疗胎粪性急性肺损伤的效果。方法68只健康新西兰兔随机分6组，用20％健康新生儿胎粪混悬液3ml／kg造模，再行机械通气。使用PLV组：全氟化碳（PFC）按3ml／kg注入兔肺内，再机械通气。造模后6h处死动物，取兔肺进行病理学检查和评分。结果相对于常频组（3．0±0），常频（PLV）组（2．4±0．6）和高频（PLV）组（2．4±0．6）可以明显降低炎性细胞浸润（P〈0．01），且高频组（2．1±0．3）也有类似作用（P〈0．05）。只有高频（PLV）组（1．0±0．7）的肺水肿情况好于常频组（2．0±0．8）（P〈0．01）。常频组（2．6±0．5）较容易出现小气道损伤，常频（PLV）组（1．1±0．4）和高频（PLV）组（0．9±0．3）的小气道损伤则不明显（P〈0．01）。未发现PLV对肺出血有效。相对于常频组和高频组，使用PLV二组的死亡率较低（21．4％／14．3％）。结论PLV可以明显减轻胎粪性急性肺损伤，并对降低死亡率有一定作用，因而PLV具有临床应用的良好前景。Objective To observe the pathological change of partial liquid ventilation （PLV） through establishing the rabbit model of acute lung injury （ALl） induced by meconium aspiration. Methods Adult, healthy male or female New Zealand white rabbits were randomly allocated into six groups as follows ： （ 1 ） control group, （ 2 ） conventional mechanical ventilation （CMV） group, （ 3 ） high-frequency oscillatory ventilation （HFOV） group, （4） CMV combined with PLV group, （5） HFOV combined with PLV group and （6） normal group. The animals were anesthetized with 1% pentobarbital and tracheotomy was performed and endotraeheal tube was placed, 20% meconium fluid （3 ml/kg） was quickly injected into the lung through the endotracheal tube and arterial blood gas was analyzed 30 minutes later. ALI was indicated when P/F ratio（ PaO2/FiO2 ） was≤300 mm Hg （ 1 mm Hg = 0. 133 kPa） and Cdyn Dynamic Compliance declined by more than 30% of the baseline. The animals were then randomly allocated into one of the 6 groups. In PLV groups （ including CMV ＋ PLV and HFOV ＋ PLV） warmed （37 ℃ ） and oxygenated perfluorocarbon was slowly instilled into the lungs of the rabbits through the endolracheal tube at a low-dose 3 ml/kg, then set 15-rain positive pressure by sacculus proprius to guarantee perfluorocarbon to steadily diffuse in to the lungs. Six hours after ventilation the animals were sacrificed by using overdose of room air instillation via vein. The lungs were taken and fixed in 4% paraformaldehyde （PFA）and were stained with hematoxylin-eosin （HE）. Pathological evaluations included inflammatory manifestation, edema and hemorrhage in both alveolar and interstitial area, damages of small airway （alveolar tube and alveolar bursa） and hyaline membrane formation. One way analysis of variance, Student Newman-Keuls （SNK） method and Kruskal-Wallis （K-W） test were used for comparisons. Results With the exception of normal group 30 minutes after meconium injections

关 键 词：胎粪吸入综合征 呼吸窘迫综合征 婴儿 新生 氟碳化物液体通气 病理 学 急性肺损伤 

分 类 号：R686[医药卫生—骨科学]