等量淡水淹溺与海水淹溺对绵羊肺循环血流动力学及呼吸力学影响的随机对照研究  

Comparison of pulmonary circulation hemodynamics and respiratory mechanics induced by drowning with equal volume of freshwater and seawater in sheep: a randomized controlled study

作　　者：冯庆国[1] 安友仲[2] 魏凯[1] 赵雪峰[1] 王伟[1] 滕洪云 杨万杰[1] Feng Qingguo;An Youzhong;Wei Kai;Zhao Xuefeng;Wang Wei;Teng Hongyun;Yang Wanjie(Department of Critical Care Medicine,the Fifth Center Hospital in Tianjin,Tianjin 300450,China;Department of Critical Care Medicine,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]天津市第五中心医院重症医学科,天津300450 [2]北京大学人民医院重症医学科,北京100044

出　　处：《中华危重病急救医学》2020年第2期177-182,共6页Chinese Critical Care Medicine

基　　金：天津市滨海新区塘沽科技兴区项目(2013KJXQ01)。

摘　　要：目的:比较淡水与海水淹溺对绵羊肺循环血流动力学及呼吸力学的影响。方法:按随机数字表法将健康杂种绵羊分为淡水淹溺组(n=12)和海水淹溺组(n=12),分别经气管插管灌注淡水或海水各30 mL/kg,约5 min灌完。于淹溺前、淹溺即刻及淹溺后30、60、120 min,通过脉搏指示连续心排血量监测技术(PiCCO)监测动物体循环血流动力学参数〔心率(HR)、平均动脉压(MAP)、心排血量(CO)〕,通过呼吸机获得呼吸力学参数〔潮气量(VT)、肺顺应性(Cdyn)、氧合指数(PaO 2/FiO 2)、气道峰压(Ppeak)〕,通过PiCCO和右心漂浮导管(Swan-Ganz导管)测量肺循环血流动力学参数〔肺动脉收缩压(PAS)、肺动脉舒张压(PAD)、肺动脉楔压(PAWP)、血管外肺水(EVLW)〕。于实验终点处死动物,测定呼吸道内残留水量;经苏木素-伊红(HE)染色后观察肺组织病理学改变。结果:①体循环血流动力学:淡水和海水淹溺即刻HR、MAP、CO均较淹溺前明显升高并达峰值,且淡水淹溺组各指标明显高于海水淹溺组〔HR(次/min):170.75±1.87比168.67±2.27,MAP(mmHg,1 mmHg=0.133 kPa):172.92±1.62比159.42±3.18,CO(L/min):13.27±0.71比10.33±0.73,均P<0.05〕。②呼吸力学参数:与淹溺前比较,淡水和海水淹溺即刻PaO 2/FiO 2、VT、Cdyn明显下降,Ppeak明显升高,且海水淹溺较淡水淹溺下降或升高更为显著〔PaO 2/FiO 2(mmHg):37.83±1.99比60.42±5.23,VT(mL):86.25±7.66比278.75±9.67,Cdyn(mL/cmH 2O):8.86±0.33比23.02±0.69,Ppeak(cmH 2O,1 cmH 2O=0.098 kPa):42.17±2.69比17.67±1.15,均P<0.01〕;随着时间的推移,淡水淹溺组PaO 2/FiO 2逐步回升,而海水组呈持续下降趋势。③肺循环血流动力学参数:淡水和海水淹溺即刻PAS、PAD、PAWP均明显高于淹溺前,且淡水淹溺组明显高于海水淹溺组〔PAS(mmHg):34.58±2.87比26.75±1.66,PAD(mmHg):27.25±1.22比16.75±0.87,PAWP(mmHg):27.83±1.85比11.75±1.82,均P<0.01〕;之后淡水淹溺组PAS、PAD逐步下降,而海水淹溺组持Objective To compare the effects of freshwater and seawater drowning on sheep's pulmonary circulation hemodynamics and respiratory mechanics.Methods According to the random number table method,healthy crossbred sheep were divided into freshwater drowning group(n=12)and seawater drowning group(n=12).30 mL/kg of freshwater or seawater was infused respectively through trachea for approximately 5 minutes.Before the drowning,immediately after drowning,and 30,60,120 minutes after drowning,the systemic circulation hemodynamic parameters[heart rate(HR),mean arterial pressure(MAP),cardiac output(CO)]were monitored by pulse indicator continuous cardiac output(PiCCO);the respiratory parameters were obtained through the ventilator,including tidal volume(VT),lung compliance(Cdyn),oxygenation index(PaO2/FiO2),peak airway pressure(Ppeak)];PiCCO and the right heart floating catheter(Swan-Ganz catheter)was used to measure pulmonary hemodynamic parameters[pulmonary systolic pressure(PAS),pulmonary diastolic pressure(PAD),pulmonary artery wedge pressure(PAWP),and extravascular lung water(EVLW)].The animals were sacrificed at the end of the experiment,and the amount of residual water in the respiratory tract was measured;the pathological changes in the lung tissue were observed by hematoxylin-eosin(HE)staining.Results①Systemic circulation hemodynamics:compared with the values before drowning,HR,MAP,and CO at the time of immediately after drowning in both freshwater and seawater were significantly increased and peaked.In addition,all indicators in the freshwater drowning group were significantly higher than those in the seawater drowning group[HR(bpm):170.75±1.87 vs.168.67±2.27,MAP(mmHg,1 mmHg=0.133 kPa):172.92±1.62 vs.159.42±3.18,CO(L/min):13.27±0.71 vs.10.33±0.73,all P<0.05].②Respiratory parameters:compared with values before drowning,PaO2/FiO2,VT,and Cdyn decreased immediately in both freshwater and seawater drowning groups,Ppeak was significantly increased;in addition,the values in the seawater drowning group were decre

关 键 词：淹溺 血流动力学 肺循环 呼吸力学 呼吸道内残留液量 

分 类 号：R459.7[医药卫生—急诊医学]