肺保护性通气对肺内源性/肺外源性急性呼吸窘迫综合征模型犬呼吸力学和炎性反应的影响  

Effects of lung protective ventilation on respiratory mechanics and cytokines levels in plasma of acute respiratory distress syndrome dogs caused by pulmonary and extrapulmonary insults

作　　者：解立新[1] 刘又宁[1] 赵晓巍[2] 郝凤英[1] 曹璐[1] 刘庆峰[1] 范保星[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：《中国呼吸与危重监护杂志》2004年第3期156-159,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家自然科学基金资助 ( 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)模型犬呼吸力学、血气交换和外周血中炎性介质的变化。方法　健康雄性杂种犬 12只 ,随机分为肺内源性ARDS模型组和肺外源性ARDS模型组 ,每组 6只。采用静脉注射油酸形成肺外源性ARDS动物模型 ,应用十六烷磺基丁二酸钠盐气管内吸入形成肺内源性ARDS动物模型。动态观察肺保护性通气条件下ARDS模型犬动脉血氧合指数、二氧化碳分压、气道压力和外周血中炎性介质 (TNF α、IL 1β、IL 6及IL 10 )的变化。结果　肺损伤后ARDS模型犬氧合指数明显降低 ,外周血中炎性介质水平均明显升高 ;肺保护性通气治疗改善氧合指数和抑制炎性介质释放的效果在肺内源性ARDS犬不如肺外源性ARDS犬。结论　肺保护性通气模式对肺外源性ARDS具有良好的治疗效果 ,但对肺内源性ARDS疗效较差。Objective To observe the heterogeneous response of respiratory mechanics and inflammatory cytokines release in plasma of acute respiratory distress syndrome (ARDS) dogs caused by pulmonary and extra-pulmonary insults to lung protective ventilation treatment. Methods 12 male mongrel dogs were randomly divided into ARDSp (ARDS caused by pulmonary causes) group and ARDSexp (ARDS caused by extra-pulmonary causes) group.ARDSp dogs were inhaled detergent and ARDSexp dogs were injected oleic acid through central vein to cause lung injury.The results of arterial blood-gas (oxygenation index,arterial carbon dioxide partial pressure),airway pressure (peak pressure,plateau pressure) and cytokines (TNF-α,IL-1β,IL-6,and IL-10) in plasma under lung protective ventilation treatment were measured.Results After lung injury,arterial oxygenation index got worsen,and TNF-α,IL-1β,IL-6,and IL-10 levels increased obviously.After receiving lung protective ventilation,all dogs exhibited improvement of oxygenation and inflammatory cytokine levels but the effects were more significant in ARDSexp dogs than in ARDSp dogs .Conclusion ARDSp and ARDSexp dogs exhibt similar features of ARDS and heterougenous response to lung protective ventilation.

关 键 词：肺保护性通气 肺疾病 内源性急性呼吸窘迫综合征 外源性急性呼吸窘迫综合征 动物模型 犬 呼吸力学 炎性反应 

分 类 号：R563.8[医药卫生—呼吸系统] R459.6[医药卫生—内科学]