肺保护性通气对肺内外源性急性呼吸窘迫综合征外周血和肺泡灌洗液中炎性介质影响的比较  

Effects of lung protective ventilation on inhibiting inflammatory mediators released into plasma and bronchial alveolar lavage fluid in acute respiratory distress syndrome caused by pulmonary and extrapulmonary insults in dog

作　　者：解立新[1] 刘又宁[1] 赵晓巍[2] 陈良安[1] 郝凤英[1] 曹璐[1] 

机构地区：[1]解放军总医院呼吸科,北京100853 [2]武警总医院呼吸科

出　　处：《中国危重病急救医学》2004年第5期262-266,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金资助项目 (3 0 2 0 0 114 )

摘　　要：目的　观察在肺保护性通气条件下急性呼吸窘迫综合征 (ARDS)模型犬氧合指数以及外周血和肺不同部位 (肺上区、肺下区腹侧和肺下区背侧 )支气管肺泡灌洗液 (BAL F)中炎性介质的变化。方法　健康雄性杂种犬 2 4只 ,随机分为肺内源性 ARDS(ARDSp)实验组、ARDSp 对照组、肺外源性 ARDS(ARDSexp)实验组和 ARDSexp对照组 ,每组 6只。采用静脉注射油酸形成 ARDSexp模型 ,应用十六烷磺基丁二酸钠盐气管内吸入形成 ARDSp模型。实验组肺损伤后进行肺保护性通气〔潮气量 8ml/ kg,呼气末正压(PEEP) 10 cm H2 O(1cm H2 O=0 .0 98k Pa)〕;对照组则继续进行大潮气量通气。动态观察肺保护性通气条件下 ARDS模型犬外周血和肺不同部位 (如肺尖叶、肺心叶和肺膈叶 ) BAL F中的炎性介质 ,如肿瘤坏死因子α(TNFα)、白细胞介素 (IL 1β,IL 6 )的变化。结果　肺损伤后 ARDS模型犬氧合指数均显著恶化 ,外周血中炎性介质明显升高 (P均 <0 .0 5 ) ,ARDSp模型犬肺尖叶和心叶 BAL F中炎性介质水平明显高于 ARDSexp模型犬 (P均 <0 .0 5 )。应用肺保护性通气治疗后 ,实验组犬氧合指数有不同程度改善 ,炎性介质水平有不同程度下降 ;但 ARDSp实验组的治疗效果不如 ARDSexp实验组。结论　 ARDSexp和Objective To observe the changes in oxygenation index and inflammatory mediators in plasma and bronchial alveolar lavage fluid (BALF) of different lung areas(upper lobe,heart lobe, diaphragm lobe) in acute respiratory distress syndrome (ARDS) caused by pulmonary and extrapulmonary insults with lung protective ventilation treatment in dog. Methods Twentyfour male mongrel dogs were randomly divided into ARDSp (ARDS caused by pulmonary disease) experimental group,ARDSp control group, ARDSexp (ARDS caused by extrapulmonary disease) experimental group,and ARDSexp control group. In ARDSp dogs detergent was introduced intratracheally to cause lung injury,while in ARDSexp dogs oleic acid was given intravenously to produce lung injury. After lung injury,the dogs in the experimental groups received lung protective ventilation treatment 〔tidal volume: 8 ml/kg,positive endexpiratory pressure(PEEP): 10 cm H_2O(1 cm H_2O= 0.098 kPa )〕,and the control groups received large tidal volume ventilation (tidal volume: 14-17 ml/kg ,PEEP: 0). The contents of tumor necrosis factorα(TNFα),interleukin1β(IL1β), IL6 in plasma and BALF from different areas of dog's lung (upper lobe,heart lobe,and diaphragm lobe),and arterial blood gas under lung protective ventilation treatment were measured. Results After lung injury,the results of arterial oxygenation index were getting worse,and the contents of TNFα,IL1β,and IL6 in plasma were obviously elevated. The contents of inflammatory mediators in upper lobe and heart lobe of ARDSp dogs were higher than that of ARDSexp dogs(all P <0.05). After receiving lung protective ventilation,the symptoms in the dogs of experimental groups were gradually getting ameliorated compared to control groups,but ARDSexp experimental dogs rallied better than ARDSp experimental dogs. Conclusion There are statistical differences in the amount of inflammatory mediators released in BALF from different lung areas and arterial oxygenation amelioration between ARDSp dogs and ARDSexp dog

关 键 词：呼吸窘迫综合征 急性 肺保护性通气 炎性介质 支气管肺泡灌洗液 

分 类 号：R563.8[医药卫生—呼吸系统]