高容量血液滤过联合机械通气对犬海水型呼吸窘迫综合征的作用  

Effect of high volume hemofiltration combined with mechanical ventilation on seawater respiratory distress syndrome in canine models

作　　者：肖达平[1] 陈光明[2] 林华铿[1] 何金选[1] 陈建[1] 

机构地区：[1]南京军区福州总医院肾内科福建医科大学福总临床学院,福州350025 [2]南京军区福州总医院儿科

出　　处：《中华肾脏病杂志》2011年第10期769-774,共6页Chinese Journal of Nephrology

基　　金：南京军区医学科学技术研究“十一五”计划课题项目（06MA141）

摘　　要：目的建立稳定的海水型呼吸窘迫综合征（SW—RDS）犬模型，探讨高容量血液滤过（HVHF）联合机械通气（MV）对海水淹溺后发生SW—RDS的疗效。方法采用健康杂种犬10只，随机分为2组：（1）单纯MV组（n=5）：实验犬在模型成功后行MV；（2）HVHF＋MV组（n=5）：模型成功后在MV的基础上联合HVHF。两组均连续观察4h。在气管插管成功稳定15rain后（基础状态）、成模、治疗60min、120min、180min、240min时记录平均动脉血压（MAP）、心率（HR）、中心静脉压（CVP），进行动脉血气分析，采集静脉血标本以测血浆渗透浓度；另于基础状态、成模、治疗120min、240min采集静脉血标本以测炎性介质（IL-8、IL-6、TNF-α）；实验结束后取肺组织标本行光镜及电镜检查。结果（1）在治疗4h后两组实验犬均存活。（2）血氧分压（PaO：）及氧饱和度（SaO2）均有所上升，HVHF＋MV组较MV组改善更明显（P〈0．05）；HVHF＋MV组pH、实际碳酸氢根（AB）、剩余碱（BE）较MV组显著改善（P〈0．05），恢复至基础状态水平。（3）两组在治疗4h过程中MAP、HR、CVP均保持稳定，治疗240min后MAP、HR、CVP与成模时比较差异无统计学意义；两组间相同时间点比较差异亦无统计学意义。（4）MV组在治疗4h过程中，血浆渗透浓度保持稳定，与成模时比较差异无统计学意义。HVHF＋MV组在治疗240min后血浆渗透浓度较MV组同时间点显著升高（P〈0．05），较同组成模及治疗180min时亦显著升高（P〈0．01）。（5）HVHF＋MV组血浆炎性介质（IL-8、IL-6、TNF-α）在治疗240min后与MV组同时间点比较显著减少（P〈0．01）；MV组治疗240rain后IL-8、TNF-α较成模型时比较明显升高（P〈0．05）。（6）肺组织病理提示，HVHF＋MV组肺组织炎性反应、水肿、肺泡上皮损伤等情况较MV组有所改善。结论HVHF＋MV能明显改善犬SW—RD的低氧血症及�Objective To investigate the effect of high volume hemofiltration （HVHF） combined with mechanical ventilation （MV） on seawater respiratory distress syndrome （SW-RDS） canine models. Methods Ten nomal hybrid dogs were randomly assigned into two groups： MV group （MV group, n=5）, all the animals only received MV after establishing model successfully; HVHF combined with MV group （HVHF＋MV group, n=5）, all were received HVHF plus MV after establishing model successfully. Both groups were observed for 4 hours. Mean arterial pressure （MAP）, heart rate （HR）, central venous pressure （CVP）, arterial blood gas and venous plasma osmotic pressure were detected at baseline, 0 min （model establishment）, 60 min, 120 min, 180 min, 240 min after treatment. Venous blood was collected to detect inflammatory mediators （IL-8, IL-6, TNF-α） at baseline, 0 min, 120 min, 240 min after treatment. The lung pathology was examined at the end of the experiment. Results （1）All the animals were suvival after four hous of treatment in both groups. （2）Partial pressure of oxygen （PaO2） and 02 saturation （SaO2） rised after four hours of treatment in both groups （P〈0.05）, and HVHF＋MV group was better than MV group. After 4 hours of treatment, pH, actual bicarbonate （AB）, bases excess （BE） in HVHF＋MV group were significantly better than those in MV group （P〈0.05）, recovering to the baseline values. （3）MAP, HR, CVP were stable during the four hours of treatment, and compared with 0 min, there was no significant differences after 4 hours of treatment in both groups. There were no significant differernces at the same time of treatment in both groups. （4）Plasma osmotic pressure were stable during the four hours of treatment, and compared with 0 min, there was no significant difference in MV group. But in HVHF＋MV group, osmotic pressure was significantly higher after 4 hours of treatment than that at the same time in MV group （P〈0.05）, and compared with 0 min

关 键 词：血液滤过 呼吸 人工 溺水 呼吸窘迫综合征 动物 

分 类 号：R563.8[医药卫生—呼吸系统]