HFOV联合ECMO对重度烟雾吸入性损伤兔肺功能的影响  

Effects of high frequency oscillatory ventilation combined with extracorporeal membrane oxygenation on lung function of rabbits with severe smoke inhalation injury

作　　者：付忠华[1] 熊振芳[2] 廖新成[1] 刘名倬[1] 郭光华[1] FU Zhonghua;XIONG Zhenfang;LIAO Xincheng(Department of Burns,First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院烧伤科,南昌330006 [2]南昌大学第一附属医院病理科,南昌330006

出　　处：《江西医药》2018年第12期1380-1384,共5页Jiangxi Medical Journal

基　　金：江西省教育厅科技计划项目;编号GJJ150252;江西省自然科学基金青年项目;编号20151BAB215019

摘　　要：目的探讨高频震荡通气(HFOV)联合体外膜氧合(ECMO)对重度烟雾吸入性损伤兔肺功能和肺组织学的影响。方法将新西兰大白兔40只制成重度烟雾吸入性损伤模型,按随机数字表法分为4组:CMV组、CMV+ECMO组、HFOV组、HFOV+ECMO组,每组10只,伤后分别行相应通气治疗8h。于伤前、致伤后即刻及治疗2h、4h、6h、8h分别记录4组兔血气分析指标(pH值、PaO_2、PaCO_2水平)。治疗8h后处死动物,对上述实验兔行肺组织病理学观察及肺损伤程度评分。所得数据行秩和检验、重复测量方差分析、LSD-t检验。结果 (1)4组兔致伤后即刻PaO_2水平与组内伤前值比较均显著下降(P<0.01);4组兔治疗各时相点PaO_2水平与组内伤后即刻比较均显著升高(P<0.01);治疗2h、4h、6h、8h,HFOV+ECMO组PaO_2水平均高于CMV组、HFOV组和CMV+ECMO组(P<0.05);HFOV组在治疗4h、6h、8h,PaO_2水平均高于CMV+ECMO组和CMV组(P<0.05);CMV+ECMO组在治疗4h、6h、8h,其PaO_2高于CMV组(P<0.05);治疗2h、4h、6h、8h,HFOV+ECMO组和CMV+ECMO组PaCO_2水平均低于相应时相点HFOV组和CMV组(P<0.05);HFOV+ECMO组与CMV+ECMO组之间治疗各时相点PaCO_2水平比较,差异无统计学意义(P>0.05);4组兔各时相点pH值水平比较,差异均无统计学意义(P>0.05)。(2)4组兔肺泡腔内均可见炎性渗出及出血表现,部分肺泡腔囊状扩张或萎陷,细支气管粘膜出现不同程度的变性、坏死,腔内炎性渗出物附着,以CMV组损伤最为明显,HFOV+ECMO组损伤明显减轻。(3)CMV组、CMV+ECMO组、HFOV组、HFOV+ECMO组肺组织损伤评分分别为(3.71±0.22)分、(3.38±0.20)分、(2.87±0.31)分、(2.35±0.20)分,组间两两比较,差异均有统计学意义(P<0.05)。结论 HFOV联合ECMO能明显改善重度烟雾吸入性损伤兔气体交换,减轻肺组织损伤。因此,可以看作治疗重度烟雾吸入性损伤的一种合适选择。Objective To study the effects of high frequency oscillatory ventilation(HFOV)combined with extracorporeal membrane oxygenation(ECMO)on lung function and lung histopathology in rabbits with severe inhalation injury.Methods 40 rabbits were inflicted with severe inhalation injury and divided into group CMV、CMV+ECMO、HFOV、HFOV+ECMO according to the random number table,with 10 rabbits in each group.Then they received corresponding ventilation for 8 hours respectively.Blood gas analysis results(pH valus,PaO2 and PaCO2)were recorded before injury,immediately after injury,and at post ventilation hour(PVH)2,4,6,and 8.The rabbits of 4 groups were sacrificed at PVH 8.Lung injury score examination was conducted in 4 groups.Data were processed with rank sum test,analysis of variance of repeated measurement,and LSD-t test.Results⑴The PaO2 levels in 4 groups were significantly decreased immediately after injury,compared with those before injury(P<0.01).The PaO2 levels in 4 groups from PVH 2 to PVH 8 were significantly increased,compared with those observed immediately after injury(P<0.05).At PVH 2,4,6,and 8,PaO2 levels in group HFOV+ECMO were significantly higher than those in the other 3 groups(P<0.05).At PVH 4,6,and 8,PaO2 levels in group HFOV were significantly higher than those in group CMV+ECMO and group CMV(P<0.05).At PVH 4,6,and 8,PaO2 levels in group CMV+ECMO were significantly higher than those in group CMV(P<0.05).At PVH 2,4,6,and 8,PaCO2 levels in group HFOV+ECMO and group CMV+ECMO were significantly lower than those in group HFOV and group CMV(P<0.05).No statistically significant differences were observed in PaCO2 level at each time point between group HFOV+ECMO and group CMV+ECMO(P>0.05).No statistically significant differences were observed in pH level at each time point among 4 groups(P>0.05).⑵Inflammatory cell infiltration and bleeding in the lung were observed in alveolar space in 4 groups.Part of alveolar dilatation or collapse,bronchial mucosa appeared different degrees of degeneration,necrosis,infl

关 键 词：高频振荡通气 烟雾吸入性损伤 体外膜肺氧合 炎症 氧合作用 

分 类 号：R644[医药卫生—外科学]