俯卧位通气加肺复张对急性呼吸窘迫综合征的作用  

Effects of ventilation in prone position combined with recruitment maneuver on lung injury in dogs with acute respiratory distress syndrome

作　　者：许启霞[1] 詹庆元[1] 王辰[1] 庞宝森[1] 杜敏捷[1] 

机构地区：[1]北京市呼吸病研究所,首都医科大学附属北京朝阳医院,北京100020

出　　处：《中国危重病急救医学》2008年第10期592-596,I0001,共6页Chinese Critical Care Medicine

基　　金：北京市科技新星计划项目（2005803）

摘　　要：目的评价俯卧位通气（PPV）联合肺复张（RM）对急性呼吸窘迫综合征（ARDS）犬的肺保护作用及机制。方法经股静脉快速注入油酸建立犬ARDS模型，容积控制通气，在小潮气量（VT，10ml／kg）＋高呼气末正压（PEEP，16cmH2O，1cmH2O=0．098kPa）通气基础上，按随机数字表法分为仰卧位组、俯卧位组、仰卧＋RM组、俯卧＋RM组，每组6只。测定通气后0．5、2和4h血清细胞因子。4h后经股动脉放血处死动物，开胸取肺；取左肺组织制备匀浆，测定细胞因子；取右肺测定湿／干重（W／D）比值及制备病理切片，行病理评分。结果①通气4h时仰卧＋RM组血清白细胞介素-8（IL-8）浓度明显高于其他3组（P均〈0．05），且仰卧＋RM组血清肿瘤坏死因子-α（TNF—α）浓度明显高于俯卧位组及俯卧＋RM组（P均〈0．05）。②俯卧位组及俯卧＋RM组背侧肺组织匀浆中IL-8浓度明显低于仰卧位组（P均〈0．05），TNF—α浓度明显低于仰卧＋RM组（P均〈0．05）。③俯卧位组、俯卧＋RM组右肺W／D比值明显低于仰卧位组及仰卧＋RM组（P均〈0．05）。④俯卧位组及俯卧＋RM组背侧病理评分显著低于仰卧位组及仰卧＋RM组（P均〈0．05）。结论在犬ARDS模型中，予以小VT＋PEEP的肺保护性通气时，在俯卧位实施RM可以减轻肺损伤。Objective To evaluate protective effect and its mechanism of prone position ventilation （PPV） combined with recruitment maneuver （RM） as a lung protective ventilation strategy on oleic acid-induced acute respiratory distress syndrome （ARDS） in dogs. Methods Twenty-four oleic acid-induced ARDS dogs were ventilated with volume controlled ventilation （VCV） ： 16 cm H2O （1 cm H2O=0. 098 kPa） of positive end-expiratory pressure （PEEP） and 10 ml/kg of tidal volume （VT）. All dogs were randomly divided by random digit table into four groups： supine position （SP group）, prone position （PP group）, supine position ＋ RM （SPRM group）, and prone position ＋ RM （PPRM group, 6 in each group）, and ventilated by VCV for 4 hours and then sacrificed by exsanguination. The serum levels of inflammatory mediators were measured respectively at 0.5, 2 and 4 hours. After they were sacrificed, the levels of cytokines in left lung tissue homogenate were measured. The wet/dry weight ratio of right lung was determined and histological sections of the lungs were prepured and examined. Results （1）At 4 hours, interleukin-8 （IL-8） in serum in the SPRM group was significantly higher than in other three groups （all P〈 0. 05）, tumor necrosis factor-α （TNF-α） in serum in the SPRM group was significantly higher than in the PP group and the PPRM group （all P〈0.05）. （2）IL-8 in lung tissue homogenate of the dorsal aspect of the lung in the SP group was higher than in the PP group and the PPRM group （both P〈0.05）. TNF-α in lung tissue homogenate at the dorsal aspect of the lung in the SPRM group was higher than in the PP group and the PPRM group （both P〈0.05）. （3）Wet/dry weight ratio of right lung in the PP group and the PPRM group were significantly lower than that in the SP group and the SPRM group （all P〈0.05）. （4）Pathology score of lung tissue at the dorsal aspect of the lung in the PP group and PPRM group was significantly lower than in the SP g

关 键 词：急性呼吸窘迫综合征 俯卧位通气 肺复张 肺保护性通气策略 细胞因子 病理评分 

分 类 号：R686[医药卫生—骨科学]