部分液体通气治疗吸入性损伤的剂量—效应差异  

Dose-dependent effect difference of partial liquid ventilation for dogs with inhalation injury

作　　者：朱峰[1] 郭光华[2] 熊龙[3] 胡庆宏[2] 李国辉[2] 王年云[2] 

机构地区：[1]南昌大学第一附属医院ICU [2]南昌大学第一附属医院烧伤研究所 [3]江西省人民医院骨科,江西南昌330006

出　　处：《第四军医大学学报》2009年第4期358-360,共3页Journal of the Fourth Military Medical University

基　　金：国家自然科学基金(39760073);江西省主要学科跨世纪学术和技术带头人培养计划(K990502)

摘　　要：目的:研究部分液体通气(PLV)治疗蒸气吸入性损伤的剂量—效应差异.方法:15条犬随机分成二组,氟碳(PFC)6 mL/kg组(PFC-6)和氟碳(PFC)12 mL/kg(PFC-12)组.采用蒸气吸入造成吸入性损伤模型后经气管内注入PFC实施PLV,观察治疗后30,60,90 min血气、血动力学参数变化.检测治疗2 h后血丙二醛(MDA)、铜蓝蛋白(CP);检测肺灌洗液(BALF)、肺匀浆中CP、总蛋白(TP)、白蛋白(ALB)、球蛋白(GLB).结果:PFC-6组PaO2在PLV治疗30 min后明显升高(P<0.05);PFC-12组PaO2在PLV治疗后30,60,90 min均明显升高(P<0.05).与PFC-6组相比,PFC-12组PaO2呈上升趋势,但未达显著水平(P>0.05).PLV治疗后各时点PaCO2及心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)与致伤值相比均无明显变化(P>0.05),两组之间各对应时间点也无明显变化(P>0.05).PLV后2 h,PFC-6组与PFC-12组血MDA,CP比较均无显著性差异(P>0.05),但均较各自的致伤前明显下降(P<0.05).BALF中,PFC-12组TP,ALB和GLB均较PFC-6组明显降低(P<0.05).肺匀浆中,PFC-12组的TP,ALB和GLB均较PFC-6组明显降低(P<0.05),而CP则明显增高(P<0.05).结论:PLV是一种新的通气技术,它能明显改善蒸气吸伤犬的氧合作用,对血流动力学参数无不良影响,但改善氧合未呈现剂量—效应差异.PLV可能通过抗脂质过氧化等作用减少血浆蛋白外漏,降低肺水肿的发生,并呈现剂量—效应差异.AIM： To explore the difference of dose-dependent effect of partial liquid ventilation （PLV） in treatment of dogs with steam inhalation injury. METHODS： Fifteen healthy dogs with steam inhalation injury were randomly divided into two groups： PFC 6 mL/kg group （PFC-6） and PFC 12 mL/kg group（PFC-12）. Parameters of blood gas and hemodynamics at 30, 60 and 90 min after PLV were recorded. Concentration of ceruloplasmin （CP） and malondialdehyde （MDA） in serum, total protein （TP）, albumin （ALB）, globulin （GLB）, CP in bronchoalveolar lavage fluid and lung homogenate were detected at 2 h after PLV. RESULTS： PaO2 in PFC-6 improved significantly at 30 min after PLV and PaO2 in PFC-12 improved significantly at 30, 60 and 90 rain after PLV （ P 〈0.05 ）. The improvement of PaO2 in PFC-12 was not significantly different （ P 〉 0.05 ）, though. No obvious changes were observed in PaCO2, HR, MAP and CVP in the two groups at any time points after PLV （P〉0.05）. At 2h after PLV, CP and MDA in serum were not significantly different between PFC-12 and PFC-6 groups （P〉 0.05 ）. TP, ALB and GLB in bronchoalveolar lavage fluid and in lung homogenate decreased significantly in PFC-12 compared with those in PFC-6 （both P 〈 0.05 ） but CP increased significantly （P〈0.05）. CONCLUSION： PLV is a new ventilation technology, which sig- nificantly improves PaO2 in inhalation injury and exerts no impairment on hemodynamics. PLV shows no dose-dependent effect difference in improving oxygenation. PLV may decrease leakage of serum protein in dogs with inhalation injury by anti-lipid peroxi-dant with a dose-dependent effect difference.

关 键 词：液体通气 烧伤 吸入性 剂量-效应差异 氧合 血浆铜蓝蛋白 

分 类 号：R644[医药卫生—外科学]