肺泡表面活性物质肺灌洗对急性呼吸窘迫综合征PaCO_2及PIP的影响  

Effect of surfactant lavage on pulmonary gas exchange in rabbit with ARDS induced by hydrochloric acid

作　　者：李敏[1] 刘辉[2] 王国军[3] 丁正年[4] 

机构地区：[1]扬州市第一人民医院麻醉科,225001 [2]江苏省肿瘤医院麻醉科 [3]解放军第四五四医院麻醉科 [4]南京医科大学第一附属医院麻醉科

出　　处：《临床麻醉学杂志》2009年第12期1068-1070,共3页Journal of Clinical Anesthesiology

摘　　要：目的研究肺泡表面活性物质肺灌洗治疗急性呼吸窘迫综合征(ARDS)的效果。方法用12ml/kg0.0225N的盐酸注入新西兰白兔气管内,纯氧机械通气1h后,将符合PaO2/FiO2≤150mmHg的动物随机分成五组,每组5只。分别用生理盐水(NS组)、浓度为1g/L(S1组)、3g/L(S3组)、6g/L(S6组)、12g/L(S12组)的肺泡表面活性物质肺灌洗,灌洗容量为10ml/kg,观察治疗后的PaCO2和气道吸气峰压(PIP)变化,并对肺标本行病理切片检查。结果S3组、S6组、S12组肺灌洗后PaCO2明显改善,但效果不能持久。S3组、S6组、S12组中肺泡间质充血水肿较NS组、S1组明显减轻。结论采用浓度为3g/L以上的外源性肺泡表面活性物质对盐酸诱导的ARDS行肺灌洗治疗可以改善肺通气,但效果不能持久。Objective To evalnate the effect of surfactant irrigation on pulmonary gas exchange in rabbit with ARDS induced by hydrochloric acid. Methods After the rabbits were anesthetized and mechanically ventilated via tracheotomy, lung injury was then induced via intratracheal injection of 0. 0225 N hydrochloric acid （12 ml/kg）. After ventilated for 1 hour, the animals with PaO2/FiO2≤ 150 mm Hg were then randomized into five groups with five animals each. Lung lavage was then performed with saline in group NS, 1 g/l. pulmonary surfactant in group S1 , 3 g/L in group S,6 g/L in group S6 ,or 12 g/L in group S12. The lavage volume was 12 ml/kg in all rabbits. Results PaCO2 decreased markedly in a short period of about 90 minutes in groups of S3 ,S1 and S12 with less alveolar pathological changes than those in groups of NS and S1 （P〈 0.05 ）. Conclusion Lung lavage with pulmonary surfactant 3 g/L or more can improve pulmonary gas exchange in rabbits with hydrochloric acid-induced lung injury temporarily.

关 键 词：急性肺呼吸窘迫综合征 肺泡表面活性物质 肺灌洗 

分 类 号：R563.8[医药卫生—呼吸系统]