静脉-静脉体外膜肺运转对绵羊胸肺顺应性及肺表面活性物质的影响  

Influence of VV-ECMO on total compliance and surfactant in healthy sheep

作　　者：张琪[1] 宋国维[2] 甘小庄[2] 黄伟雄[3] 孙丽萍[3] 李惠[3] 马广松[3] 

机构地区：[1]中国医学科学院中国协和医科大学,100730 [2]首都儿科研究所急诊科 [3]首都儿科研究所呼吸功能室

出　　处：《中华儿科杂志》2002年第9期541-544,共4页Chinese Journal of Pediatrics

摘　　要：目的　为了解静脉 静脉体外膜肺 (venovenousextracorporealmembraneoxygenation ,VV ECMO)过程中绵羊胸肺动态顺应性的变化及VV ECMO治疗对健康绵羊肺表面活性物质的影响。方法　绵羊 2 0只 ,随机分为ECMO组及供血组各 10只。供血组颈内静脉插管放血供体外循环机预充血 ;ECMO组气管插管机械通气 ,右颈内静脉及右股静脉内放置静脉导管接体外循环装置。测定ECMO前、ECMO后 5、15、30、6 0、90、12 0、180min时胸肺动态顺应性 ,同时监测动脉血压、心率及肛温。两组动物均经气管插管用生理盐水 2 0ml/kg行支气管肺灌 3次 ,分析支气管肺灌洗液中总磷脂、磷脂酰胆碱及蛋白质的浓度。结果　动物ECMO前、ECMO后 5、15、30、6 0、90、12 0、180min时胸肺动态顺应性分别为 (1 19± 0 16 )、(0 77± 0 0 9)、(0 72± 0 13)、(0 71± 0 12 )、(0 71± 0 13)、(0 71± 0 16 )、(0 71± 0 16 )及 (0 76± 0 2 0 )ml/ (mmHg·kg) ,运转前胸肺动态顺应性显著高于运转后 (P <0 0 1) ,运转后各时间胸肺动态顺应性差异无显著意义 (P均 >0 0 5 )。ECMO组支气管肺灌洗液中总磷脂、磷脂酰胆碱及蛋白质的浓度分别为 (130 2± 9 9)、(83 5± 11 6 )及 (5 2 2 4± 6 6 3)mg/L ;供血组分别为 (132 2± 8 7)?Objective To explore the effect of venovenous extracorporeal membrane oxygenation (VV ECMO )on lung function and surfactant in healthy sheep Methods Twenty healthy sheep were randomly divided into the ECMO group and blood supplied group Each group had 10 sheep Standard procedures for venovenous ECMO were used in ECMO animals Blood was siphoned from the right internal jugular venous cannula and returned to animals by the right femoral venous cannula after oxygenated by oxygenator The procedure was divided into two phases: pre ECMO mechanical ventilation and ECMO [30 ml/(kg·min)] with required mechanical ventilation Total dynamic compliances were assessed pre ECMO and after 5, 15, 30, 60, 90, 120 and 180 min during VV ECMO The arterial blood pressure, pulse and temperature were also monitored After exsanguinated through internal jugular venous, lungs of both groups were lavaged 3 times with 20 ml/kg saline through the trachea intubation Total phospholipid, phosphatidylcholine and total protein in lung lavage fluid were measured Results During the VV ECMO period, the arterial blood pressure, pulse and temperature of the animals were maintained at the normal range Total dynamic compliances pre ECMO and after 5, 15, 30, 60, 90, 120 and 180 min of VV ECMO were (1 19±0 16), (0 77±0 09), (0 72±0 13), (0 71±0 12), (0 71±0 13), (0 71±0 16), (0 71±0 16) and (0 76±0 20)ml/ (mmHg·kg), respectively The total dynamic compliance pre ECMO was higher than that of each interval time during VV ECMO ( P <0 01) There were no significant differences among the total compliance of each interval time during VV ECMO The concentrations of total phospholipid, phosphatidylcholine and total protein in lung lavage fluid in ECMO group were (130 2±1 0), (83 5±11 6) and (522 4±66 3)mg/L, respectively, and for blood supplied group, they were (132 2±8 7), (84 2±1 0) and (503 8±98 2)mg/L, respectively No significant difference was found between the two groups (

关 键 词：静脉-静脉体外膜运转 肺表面活性物质 体外膜氧合作用 肺顺应性 动物实验 

分 类 号：R459.7[医药卫生—急诊医学]