【摘要】 目的 对肺灌洗(Lavage)诱导的急性肺损伤(ALI)家猪实施以氟碳(PFC)为媒介的部分液体通气(PLV)及吸入20 ppm的一氧化氮(NO),比较二者对肺气体交换及血液动力学的影响。方法 24头健康家猪,麻醉后经气管导管肺内以生理盐水反复灌洗,直至动脉氧分压(PaO2)<100mmHg达1 h,记录气体交换及血液动力学各参数作为急性肺损伤的基础值。随机分为PLV组、NO组及对照组,PLV组肺内灌以相当于肺功能余气量(30ml/kg)的PFC,然后以普通呼吸机行常规气体通气,补充PFC4ml·kg-1·h-1以弥补蒸发损失;NO组吸入20 ppm:NO,对照组不给予其它治疗,各组每小时记录气体交换及血液动力学各参数的变化。结果 PLV组实施PLV1 h后,PaO2即从ALI时的(53±11)mmHg升高至(142±133)mm Hg,4h后达(318±109)mm Hg,与ALI时比较差异有显著性(P<0.01),亦显著高于对照组(P<0.05)。实施PLV1 h后Qs/Qt从ALI时的(57±9)％降至(42±13)％,4 h后降至(26±10)％,较ALI时差异有显著性(P<0.01),并于2h后显著低于对照组(P<0.05)。NO组的MPAP在整个实验过程中显著低于对照组(P<0.01)。NO组吸入NO 1 h后,PaO2即呈上升趋势,4 h后从ALI时的65±14升至(114±36)mmHg,与对照组比较差异有显著性(P<0.05)。同时肺内分流(Qs/Qt)及肺泡-动脉氧压差(AaDO2)降低。MAP及体循?更多还原

【Abstract】 Objective To compare the effects of partial liquid ventilation ( PLV) and nitric oxide (NO) inhalation on gas exchange and hemodynamics in acute lung injury induced by surfactant depletion in piglets. Methods 24 female piglets weighting 25-30 kg were induced with thiopental and pancuronium and maintained with continuous infusion of thiopental , fentanyl and pancuronium. The animals were tracheotomized and mechanically vetilated with oxygen( FiO2 = 1.0). Femoral artery was cannulated for artery blood sampling and blood gas analysis. Pulmonary catheter was inserted through the femoral vein for measurement of CVP, mean pulmonary artery pressure(MPAP) , PCWP, cardiac output(CO) and sampling of mixed venous blood. Acute lung injury was induced by lung lavage after the method described by Lachmann until PaO2 was lower than 100 mm Hg. Animals were randomly divided into perfluorocarbons (PFC) group, NO group and control group.The animals in PFC group received PFC(FC3280)in a intratracheal doses of 30 ml/kg, and the animals in NO group inhaled 20 ppm NO. The parameters of gas exchange and hemodynamics were measured before lung lavage, after lung lavage when the acute lung injury was established, and then every hour for four hours. Results Surfactant depletion by lung lavage induced a stable acute lung injury. PaO2 in PLV group was increased from (53 ± 11) mm Hg in ALI to (142 ± 133) mm Hg after 1 hour of instillation of PFC, and (318 ± 109) mm Hg after 4 hours of instillation of PFC and significantly higher than that in control group. Conclusion PLV with PFC and 20 ppm NO inhalation can effectively improve the lung gas exchange in the piglet with ALI. NO inhalation decreases MPAP and PLV increases PaO2 more dgrees.更多还原