肺应变对犬急性呼吸窘迫综合征模型肺水肿的影响  

Effect of lung strain on pulmonary edema in dogs with acute respiratory distress syndrome

作　　者：刘奇[1] 郑惠[2] 李雯[4] 曾庆思[4] 程哲[1] 陈荣昌[3] 

机构地区：[1]郑州大学第一附属医院呼吸与重症五科,450052 [2]郑州大学第一附属医院CT室,450052 [3]广州呼吸疾病研究所呼吸疾病国家重点实验室广州医科大学第一附属医院呼吸动力室 [4]郑州大学第一附属医院放射科,450052

出　　处：《中华医学杂志》2015年第36期2947-2951,共5页National Medical Journal of China

基　　金：国家自然科学基金（81400051）

摘　　要：目的 初步探讨肺应变大小对犬急性呼吸窘迫综合征（ARDS）模型肺水肿的影响.方法 选取20只健康比格犬,利用静脉注射油酸制作ARDS模型,按随机数字表法均分为4组,肺应变分别为1.0、1.5、2.0及2.5并分别命名为S1.0、S1.5、S2.0、S2.5组,根据肺应变、功能残气量及呼气末正压引起的肺复张容积计算潮气量,以此潮气量进行机械通气24 h,采用热稀释法测量血管外肺水指数（EVLWI）、肺血管通透性指数（PVPI）等肺水肿指标,称重法测量肺组织湿干比.结果 S1.0、S1.5、S2.0、S2.5组潮气量分别为（7.5±1.7）、（13.9±5.8）、（17.9±4.7）、（20.3±7.9） ml/kg,机械通气治疗4h后,S2.0、S2.5组的EVLWI均显著高于S1.0、S1.5组[（38.9±6.5）、（40.1±7.7）比（26.6±5.2）、（28.8±5.4） ml/kg;F=5.627,P=0.009].实验结束时S2.5组的PVPI均显著高于S1.0、S1.5、S2.0组（16.7±5.4比7.0±2.3、9.2±2.2、11.5±6.0;F=4.329,P=0.022）;S2.0、S2.5组肺组织湿干比均显著高于S1.0、S1.5组（10.4土1.2、10.8±1.5比8.3±1.2、8.0±2.2;F=5.627,P =0.009）.结论 肺应变＞2.0时明显加重ARDS模型肺水肿,肺应变＜1.5时对于肺水肿的影响较小.Objective To explore the effect of lung strain on pulmonary edema in dogs with acute respiratory distress syndrome （ARDS） preliminarily.Methods Twenty dogs were recruited to induct ARDS models by venous injection of oleic acid and grouped into Group S1.0,S1.5,S2.0,S2.5 randomly,the lung strain was previously designated as 1.0,1.5,2.0 or 2.5 for each group.The ventilation was used to support the dogs for 24 hours with tidal volume calculated from lung strain,functional residual capacity and the volume recruitment by positive end expiratory pressure.Extra vascular lung water index （EVLWI） and pulmonary vascular permeability index （PVPI） were tested by thermodilution technique and wet to dry ratio of lung tissue was evaluated by weighing method.Results The tidal volume of Group S1.0,S1.5,S2.0,S2.5 was （7.5± 1.7）,（13.9± 5.8）,（17.9 ±4.7） and （20.3 ±7.9） ml/kg,respectively.After ventilation for 4 h,EVLWI in Group S2.0 and Group S2.5 were higher than them in Group Sl.0 and Group S1.5 （（38.9±6.5）,（40.1 ±7.7） vs （26.6±5.2）,（28.8±5.4） ml/kg;F=5.627,P=0.009）.At the end of study,PVPI of Group S2.5 increased significantly versus Group S1.0,S1.5 and S2.0 （16.7 ± 5.4vs7.0±2.3,9.2±2.2,11.5±6.0;F=4.329,P=0.022）.Wet to dry ratios of lung tissue in Group S2.0 and Group S2.5 were significantly higher than Group S1.0 and Group S1.5 （10.4 ± 1.2,10.8±1.5vs8.3±1.2,8.0±2.2;F=5.627,P=0.009） after ventilation.Conclusion Lung strain above 2.0 aggravates pulmonary edema dramatically and the effect might be slight if lung strain was smaller than 1.5.

关 键 词：急性呼吸窘迫综合征 肺水肿 肺应变 犬 

分 类 号：R563.8[医药卫生—呼吸系统]