超声引导双心房输注去氧肾上腺素和前列腺素E_1对急性肺动脉高压犬肺损伤的保护作用  

Protection of ultrasound-guided biatrial infusion of phenylephrine and prostaglandin E_1 on acute pulmonary hypertension-induced lung injury in dogs

作　　者：曲良超[1] 王凤芝 罗和国[2] 郭善亮[2] 赖全图[3] 杨力[4] 徐贤亮[4] 

机构地区：[1]南昌大学第一附属医院麻醉科,南昌330006 [2]江西省人民医院麻醉科,南昌330006 [3]江西省人民医院超声科,南昌330006 [4]南昌大学医学院

出　　处：《广东医学》2014年第1期47-50,共4页Guangdong Medical Journal

基　　金：江西省科技支撑计划(编号:2010BSB00301)

摘　　要：目的运用超声引导双心房输注技术,通过左右心导管分别输注去氧肾上腺素和前列腺素E1,观察该方法对急性肺动脉高压犬肺损伤的保护作用.方法实验用杂种犬15只,不拘雌雄,体重9～13kg,均分为3组,急性肺动脉高压模型建立后,A组通过Swan-Ganz漂浮导管至右心房给予前列腺素E1脂微球载体制剂20ng/（kg·min）,通过超声引导,经股动脉逆行置入左心导管至左心房,给予去氧肾上腺素2μg/（kg·min）;B组通过Swan-Ganz漂浮导管至右心房给予同样的两种药物和剂量;C组通过Swan-Ganz漂浮导管至右心房给予等体积的生理盐水.观察并记录各组犬在不同时间的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、中心静脉压（CVP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）和心排出量（CO）,并计算出心指数（CI）、全肺阻力指数（PVRI）和体循环阻力指数（SVRI）,并检测同时点的血浆乳酸脱氢酶（LDH3）.结果在超声引导下,可以成功地经股动脉放置左心导管至左心房,肺栓塞肺动脉高压模型建立成功,给予药物治疗后,与C组比较,A、B组T3～T5时段MPAP下降（P〈0.05）,与A组比较,B组T3～T5时段CI、体循环的MAP和SVRI下降（P〈0.05）,与C组比较,A、B组T4、T5时段LDH3下降（P〈0.05）.结论通过超声引导双心房输注分别给予去氧肾上腺素和前列腺素E1能够有效地降低肺动脉压,同时改善急性肺动脉高压状态下肺脏灌注和缺血缺氧,起到一定的肺保护作用.Objective To evaluated the efficacy of ultrasound - guided biatrial infusion of phenylephrine and prostaglandin E1 on the treatment of acute pulmonary hypertension （APH） - induced lung injury in dogs. Methods Fifteen mongrel dogs （9- 13 kg）, were allocated into three groups. After induction of APH, Lipo PGEl [20 ng/（kg ·min） 1 in atrium dextrum by Swan -Ganz floating catheter and given phenylephrine [ 2 ixg/（ kg ·min） ] in atrium pulmo- nale by left cardiac catheter uncder ultrasound - guided through femoral artery to the left atrium or left ventricle were given in Group A ; while same drugs through Swan - Ganz floating catheter were given in Group B and placebo saline were given in Group C. The haemodynamics, including HR, MAP, SpO2 , CVP, MPAP and PCWP, and plasma LDH3 were recorded for calculation of cardiac emissions （CO） , cardiac index （ CI ） , total pulmonary resistance index （ PVRI ） and systemic vascular resistance index （SVRI）. Results APH model was successfully constructed. Left ventricular catheter was suc-cessfully placed through femoral artery to the left atrium under ultrasound guidance. Pulmonary artery pressures and LDH3 were significantly reduced in Group A and B when comparing with Group C （P 〈 0. 05）. CI circulation, MAP and PVRI were reduced in Group B when comparing with Group A （P 〈 0. 05 ）. Conclusion Ultrasound -guided biatrial infusion of phenylephrine and Lipo PGE1 effectively reduces pulmonary hypertension and improves pulmonary perfusion, ischemia and hypoxia; thus produces protective effects on lung injury in APH.

关 键 词：超声引导 急性肺动脉高压 双心房输注 肺损伤 

分 类 号：R587.2[医药卫生—内分泌]