家兔肺复张术对急性肺损伤早期肺脏力学性质的影响  

Effects of recruitment maneuver on mechanics of lung in early period of acute lung injury in rabbits

作　　者：胡振宇[1] 苏立伟[2] 

机构地区：[1]航天中心医院呼吸科,北京100049 [2]武警总医院胸外科,北京100039

出　　处：《武警医学》2009年第6期489-491,共3页Medical Journal of the Chinese People's Armed Police Force

基　　金：国家自然科学基金资助(编号:30340030)

摘　　要：目的研究急性肺损伤(Acute lung injury,ALI)早期给予肺复张(Recruitment maneuver,RM)干预后家兔肺脏力学性质的改变情况。方法18只雄性新西兰家兔随机分为3组,每组6只。(1)对照组:单纯给予机械通气;(2)ALI组:建立内毒素ALI模型并给予机械通气;(3)ALI+RM组:先建立内毒素ALI模型并给予机械通气,再予RM干预。实验中测定各组动物在给内毒素脂多糖前、6 h后及第四次肺复张(RM4)干预后各点(或对应时间点)的压力-容量曲线及下拐点值。结果压力-容量曲线的下拐点值:给内毒素脂多糖6 h后,ALI组及ALI+RM组的压力-容量曲线的下拐点(lower inflectionpoint,LIP)值均较同组给内毒素脂多糖前升高,差异有统计学意义(P<0.05);ALI+RM组在4次RM干预后LIP值较同组给内毒素脂多糖后6 h时下降,差异有统计学意义(P<0.05);而ALI组在对应时间点的LIP与同组给内毒素脂多糖后6h相比差异无显著性(P>0.05)。结论急性肺损伤早期给予RM干预,压力-容量曲线上的LIP值显著下降,从而在一定程度上改善了肺脏的力学性质。Objective To study the mechanics after sequential recruitment maneuvers （RMs） in the early period of acute lung injury（ALl） in rabbits. Methods Eighteen male New Zealand rabbits were recruited in the study. All rabbits were ventilated with ventilator under general anesthesia and then were divided into three groups randomly. （ 1 ） Control group ： the rabbits were ventilated with neither instillation of lipopolysaccaride （LPS） nor RM. （ 2 ） ALl group ： the model of Aid was developed by using LPS （0.8 mg/kg） in the rabbits of ALl group and they were ventilated with an appropriate positive end-expiratory pressure （PEEP） （lower in- flection point, LIP ＋2 cm H20） only. （3） ALl ＋ RM group：after ALI was made, RM （continuous positive airway pressure,CPAP 30 cm H2 O,30 s） was given to the rabbits every hour for 4 times with an appropriate PEEP （LIP＋2 cm H2O）. Pressure-volume curve （P-V curve） and lower inflection point （LIP） were measured before and after the interventions. Results LIP in P-V curve： in the whole study, the LIP in control group showed no significant change （ P 〉 0.05 ）. Six hours after LPS was given, the LIP in P-V curve of ALI and ALI＋ RM group was elevated significantly over the baseline （P 〈 0.05 ）. After 4 RMs, the LIP was reduced significantly in Aid ＋ RM group （P 〈 0.05 ）, but the LIP in Aid group showed no significant change （P 〉 0.05）. Conclusion The LIP of P-V curve decreases after giving RM therapy in the rabbit acute lung injury model. It implies that RM might improve the mechanics of lung.

关 键 词：急性肺损伤 内毒素 肺复张术 下拐点 

分 类 号：R563.8[医药卫生—呼吸系统] R459.7[医药卫生—内科学]