肺保护性通气对犬海水淹溺型肺水肿的治疗作用  

Therapeutical effect of seawater drowning pulmonary edema of dog using lung protective ventilation strategy

作　　者：金发光[1] 李王平[1] 南岩东[1] 傅恩清[1] 谢永宏[1] 孙瑞琳[1] 刘伟[1] 

机构地区：[1]解放军第四军医大学唐都医院呼吸内科,西安710038

出　　处：《中国急救医学》2010年第8期716-719,共4页Chinese Journal of Critical Care Medicine

基　　金：军队“十一五”攻关项目（No.08G-102）;陕西省攻关项目（No.2008K14-08）

摘　　要：目的观察肺保护性通气对海水淹溺型肺水肿（PE—SWD）犬肺内气体交换、气道力学、血流动力学及外周血炎性介质的影响，并与常规机械通气进行比较。方法健康成年杂种犬15只，经气管插管灌人海水形成PE—SWD模型后，随机分为3组（n=5）：阳性对照组（Ⅰ组），常规机械通气治疗组（Ⅱ组），肺保护性通气治疗组（Ⅲ组）（VT8mL／kg＋PEEP8cmH2O）。治疗180min，分别观察各组治疗前后不同时间点动脉血气、呼吸力学、血流动力学以及外周血炎性介质的变化。结果肺保护性通气治疗后海水淹溺型肺水肿犬动脉血气、呼吸力学、血流动力学以及炎性介质指标均较Ⅰ、Ⅱ组明显改善（P〈0．05）。结论肺保护性通气可明显改善PE—SWD犬动脉血气，并能提高肺顺应性、降低气道峰压、降低肺动脉压、减少肺组织损伤。肺保护性通气模式可能是治疗PE—SWD的有效方法，值得临床实践应用。Objective To observe the influence of gas exchange, respiratory dynamics, hemodynamics, inflammatory mediators of peripheral blood in seawater drowning pulmonary edema （PE -SWD）of dog using lung protective ventilation strategy. Methods Fifteen healthy and mongrel dog modes of PE - SWD by tracheal intubation and seawater injection were randomly divided into three groups： positive control （ Ⅰ group）, conventional mechanical ventilation group （ Ⅱ group ） and lung protective ventilation group（ Ⅲ group, VT 8 mL/kg ＋ PEEP 8 cm H2O）. Arterial blood gas, respiratory dynamics, hemodynamics and inflammatory mediators of peripheral blood in each group were observed at different point of time during 180 rain treatment. Results Comparing with positive control and conventional mechanical ventilation group, lung protective ventilation strategy can significantly improve arterial blood gas, respiratory dynamics, hemodynamics and inflammatory mediators of peripheral blood （ P 〈 0.05 ）. Conclusion Lung protective ventilation strategies can significantly improve arterial blood gas and lung compliance, and reduce airway peak pressure and lung tissue injury of PE - SWD dog. It is an effective method to treat PE -SED and deserves utilization in the clinical practice.

关 键 词：犬 海水淹溺 肺水肿 肺保护性通气 常规机械通气 

分 类 号：R605.97[医药卫生—急诊医学]