早期生理盐水全肺灌洗治疗烟雾吸入伤犬的近期效果  

The short-term effects of the treatment of acute severe smoke inhalation with normal saline massive bronchoalveolar lavage in early post-injury stage in dogs

作　　者：聂发传[1] 杨宗城[2] 刘志远[2] 吴娅[2] 罗奇志[2] 黄跃生[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烧伤研究所,重庆400038

出　　处：《重庆医学》2002年第10期910-912,共3页Chongqing medicine

基　　金：全军"九五"指令性课题 (96L0 4 3)

摘　　要：目的　探讨早期大容量生理盐水全肺灌洗治疗重度烟雾吸入伤犬的近期效果。方法　犬急性重度锯木屑燃烧烟雾吸入伤后 1h进行生理盐水左肺大容量灌洗 ,30min后行右侧肺灌洗 ,随后PEEP控制呼吸 2 4h。检测肺灌洗对犬病程中肺功能、离体脏器病理和生化改变的影响。结果　肺灌洗犬肺组织含水量显著增加而心脏、肾脏组织含水量有减少趋势 ,血浆和肺组织匀浆中细胞因子、自由基代谢产物及炎症反应相关酶含量和活力升高的幅度均小于未灌洗犬。但肺灌洗犬伤后 2 4h内肺功能未表现出改善作用 ,表现在肺灌洗后PaO2 始终低于未灌洗犬。结论　肺灌洗可减轻吸入伤原发性损害和继发性全身炎症反应 ,但肺泡积水影响气体交换导致近期肺功能低下。如何避免这一不良影响是肺灌洗疗法有效使用前必须解决的问题。Objective To observe the short time effect of the treatment of acute severe smoke inhalation with normal saline massive bronchoalveolar lavage in early post injury stage in dogs. Methods The left massive bronchoalveolar lavage was achieved at 1 hour after injury and then the contralateral lung was lavaged half an hour later. The effects of lung lavage on the changes of pulmonary functions, pathologic condition of important organs and certain inflammatory mediums and cytokines in the tissues of lungs were investigated in 24h. And the changes of them were compared with those of normal dogs and smoke inhalation injured dogs treated only with controlled positive end expiratory pressure respiration. Results The increasing magnitude of cytokines, wastes of free radical metabolism,water content in right kidney and cardiac in dogs undergoing the therapeutic lavage showed lower than those in the dogs without undergoing the lung lavage. Nevertheless, PaO 2 in dogs in Group B remained lower than that in dogs without receiving the therapeutic lavage. It was demonstrated that the water remained in alveolar was the key factor to injure the gas exchange. Conclusion The short term effect of normal saline massive bronchoalveolar lavage in early post injury stage on acute severe smoke inhalation injury in dogs was reliable and it was showed that the primary damage and the secondary inflammatory damage was alleviated. Meanwhile, the water remained in alveolar was the key factor to injure the gas exchange. The following work we should do is to lower the harmful influence and to enhance the therapeutic effect.

关 键 词：生理盐水 全肺灌洗 治疗 烟雾吸入伤 肺功能 近期疗效 动物实验 

分 类 号：R644[医药卫生—外科学]