肺保护性通气策略对百草枯诱导急性呼吸窘迫综合征家猪血管外肺水的作用  

Effects on extravascular lung water of lung protective ventilation strategy applied on piglets with acute respiratory distress syndrome induced by paraquat

作　　者：王金柱 郑春雷 郑惠 刘晓刚 兰超[2] Wang Jinzhu;Zheng Chunlei;Zheng Hui;Liu Xiaogang;Lan Chao(Department of Intensive Care Unit,High Tech Zone,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China;Department of Emergency Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450002,China)

机构地区：[1]郑州大学附属郑州中心医院高新区医院重症医学科,郑州450007 [2]郑州大学第一附属医院急诊医学部,郑州450002

出　　处：《中华劳动卫生职业病杂志》2022年第1期7-11,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：河南省高等学校重点科研项目计划(19A320093)。

摘　　要：目的研究脉搏指示连续心排血量(PiCCO)监测下肺保护性通气策略对百草枯(PQ)诱导急性呼吸窘迫综合征(ARDS)家猪血管外肺水的影响。方法于2020年6月,采用PQ诱导家猪ARDS模型,造模成功后所有家猪均接受机械通气并按照吸入潮气量(V_(T))分为小V_(T)组(6 ml/kg)、中V_(T)组(10 ml/kg)和大V_(T)组(15 ml/kg),每组各5只,设置呼气末正压(PEEP)为10 cmH_(2)O。分别于造模前(基础值)、造模成功时(t_(0))及机械通气后2 h(t_(2))、4 h(t_(4))和6 h(t_(6))时进行动脉血气分析,计算氧合指数(OI),并测量血管外肺水指数(ELWI)和肺血管通透性指数(PVPI)等指标;同时采用苏木精-伊红(HE)染色法分别在造模前、t_(0)和t_(6)时观察肺组织病理学变化。结果造模成功后,各组t_(0)时心率(HR)、平均动脉压(MAP)和二氧化碳分压(PaCO_(2))水平高于基础值,而pH值、氧分压(PaO_(2))及OI水平低于基础值(P<0.05);接受机械通气后,各组t_(2)、t_(4)、t_(6)时HR和MAP水平低于t_(0)时,t_(4)、t_(6)时PaCO_(2)水平高于t_(0)时,差异均有统计学意义(P<0.05);而各组PaO_(2)和OI水平在通气后呈先上升后下降的趋势;中、大V_(T)组t_(2)、t_(4)、t_(6)时MAP、PaO_(2)、PaCO_(2)及OI水平低于同期小V_(T)组(P<0.05)。各组家猪t_(0)时ELWI和PVPI均高于基础值(P<0.05);小V_(T)组ELWI在t_(6)时低于同组t_(0)时以及中、大V_(T)组t_(6)时(P<0.05)。HE染色发现,造模成功后家猪肺泡组织充血水肿、毛细血管肿胀,红细胞渗出,肺泡间隔增宽,t_(6)时各组肺组织可见肺泡融合、肺泡间隔进一步增宽,部分可见肺泡间隔断裂,小V_(T)组损伤程度最轻。结论肺保护性通气策略可减少PQ中毒家猪血管外肺水,减轻ARDS,改善氧合状况。Objective To study the effects on extravascular lung water of lung protective ventilation strategy applying on piglets with acute respiratory distress syndrome(ARDS)induced by paraquat(PQ)under pulse indicating continuous cardiac output(PiCCO)monitoring.Methods The piglets models with ARDS induced by PQ were established in June 2020 and all of them were received mechanical ventilation and divided into three groups according to tidal volume(V_(T)):small V_(T)group(6 ml/kg),middle V_(T)group(10 ml/kg)and large V_(T)group(15 ml/kg),there were 5 piglets in each group.The positive end expiratory pressure(PEEP)were all setup on 10 cmH_(2)O.The indexes such as arterial blood gas analysis,oxygenation index(OI),extravascular lung water index(ELWI)and pulmonary vascular permeability index(PVPI)were monitored at time of before the model was established(baseline),time of the model was established(t_(0))and 2 h(t_(2)),4 h(t_(4)),6 h(t_(6))after mechanical ventilation.Lung tissue were punctured at time of baseline,t_(0)and t_(6)to be stained by Hematoxylin-eosin(HE)staining and pulmonary pathology were observed under light microscopy.Results The heart rate(HR),mean arterial pressure(MAP)and partial pressure of carbon dioxide(PaCO_(2))of all groups were higher than the base value while the pH values,partial pressure of oxygen(PaO_(2))and OI were lower than the base value when the models were established(P<0.05).After mechanical ventilation,the HR and MAP values of all groups at t_(2),t_(4)and t_(6)were lower than t_(0)while the PaCO_(2)of t_(4)and t_(6)were all higher than t_(0),the differences were statistically significant(P<0.05).The PaO_(2)and OI of all groups showed a trend of rising at first and then decreasing after mechanical ventilation.The MAP,PaO_(2),PaCO_(2)and OI of the middle V_(T)group and large V_(T)group were apparently lower than that of the small V_(T)group at t_(2),t_(4)and t_(6)(P<0.05).The ELWI and PVPI at t_(0)of all groups were higher than that of baseline(P<0.05).The ELWI of the small V_(T)group at t_(6

关 键 词：百草枯 急性呼吸窘迫综合征 肺保护性通气策略 脉搏指示连续心排血量监测 血管外肺水 氧合指数 

分 类 号：R563.8[医药卫生—呼吸系统] R595.4[医药卫生—内科学]