机械通气对严重烟雾吸入伤犬早期肺表面活性物质的影响  

Effect of four mechanical ventilation modes on pulmonary surfactant in early stage after severe smoke inhalation injury in dogs.

作　　者：陶国才[1] 杨宗城[2] 刘志远[2] 傅琼芳[2] 何保斌[2] 魏钜菊[2] 黎鳌[2] 

机构地区：[1]第三军医大学西南医院麻醉科,重庆400038 [2]第三军医大学西南医院全军烧伤研究所,重庆400038

出　　处：《重庆医学》2002年第10期899-902,共4页Chongqing medicine

基　　金：全军"九五"指令性课题 (96L0 4 3)

摘　　要：目的　观察四种通气模式对严重烟雾吸入伤犬早期肺表面活性物质的影响。方法　 4 2只犬分为PEEP组、PC组、CPAP组、IRV组、致伤对照组和正常组。伤后 1h开始连续 2 4h机械通气。FiO2 =0 .4 ,PIP =1 6kPa,PEEP CPAP =0 6kPa ,除IRV组I∶E =2∶1外 ,其他通气组I∶E =1∶2。结果　伤后四种通气模式可显著降低VD VT,减缓Cdyn下降幅度和QS QT 上升幅度 ;伤后 2 4hCPAP组和PEEP组治疗效果显著好于致伤对照组、PC组和IRV组。同时 ,PEEP组和CPAP组BALF蛋白含量显著低于、TPL显著高于致伤对照组、PC组和IRV组。BALF中TPL含量与蛋白含量呈显著负相关、与Cdyn呈显著正相关。各机械通气组STMIN显著低于、Ha显著高于致伤对照组。结论　本实验所采用的通气模式及参数于烟雾吸入伤早期持续 2 4h通气治疗可通过机械性扩张肺泡或复张塌陷的肺泡 ;促进PS分泌 ;阻止大量血浆蛋白渗入肺泡 ,减缓PS的降解和失活 ,促进PS合理分布等从而减轻减缓肺不张的发生发展。其中持续气道正压 (PEEP CPAP)有益作用更为明显。Objective To observe the effect of four mechanical ventilation modes on pulmonary surfactant in early stage after severe smoke inhalation injury in dogs. Methods 42 healthy dogs were divided into 6 groups: PEEP,PC,CPAP,IRV, injured control, normal control(n=7 in each group). Continuous 24 hours mechanical ventilation were performed one hour after smoke inhalation injury .FiO 2=0.4,PIP=1 6kPa,PEEP/CPAP=0 6kPa, I∶E=2∶1 in IRV group,I∶E=1∶2 in other ventilation groups. Results Four modes of mechanical ventilation could result in decrement of VD/VT, attenuation of decreasing scope of dynamic compliance and increasing scope of QS/QT. 24 hours after injury there are more benefic effects on VD/VT ,Dynamic Compliance and QS/QT in CPAP and PEEP groups than in injured control, PC and IRV groups. Meanwhile, protein concentration decreased and TPL level increased markedly in BALF in CPAP and PEEP groups than in injured control, PC and IRV groups. The change of TPL level in BALF is correlated significantly with the decrease of protein concentration in BALF and increase of dynamic compliance. STMIN decreased and Ha increased markedly in each mechanical ventilation groups than in injured control group. Conclusion modes and parameters with which continuous 24 hours mechanical ventilation in this study could increase alveolar radius and re expand collapsed alveolar mechanically, promote PS secretion, prevent proteins transfering from pulmonary interstitial to alveolar space, attenuate PS degradation and devitalization , facilitate PS rational distribution to attenuate the severity and retard the development of alveolar collapse and atelectasis. In which continuous positive airway pressure (PEEP/CPAP) have more beneficial effects .

关 键 词：机械通气 肺表面活性物质 吸入性损伤 烧伤 动物实验 

分 类 号：R644[医药卫生—外科学]