一氧化氮吸入对脓毒症幼猪血流动力学和氧合功能的影响

Effects of inhaled nitric oxide on hemodynamics and oxygenation in piglets with sepsis

目的:研究脓毒症幼猪吸入一氧化氮(N0)后心脏指数(CI)与氧合指数的变化。方法:静脉注入革兰氏阴性杆菌内毒素(LPS)诱导脓毒症幼猪模型。随机分为两组:NO组(n=8)为脓毒症模型建立后,在容量控制通气基础上持续吸入80 ppmNO 30 min;对照组(n=4)为脓毒症模型建立后单纯容量控制通气,观察30min以确定模型的稳定性并与NO组比较。利用脉波指示剂连续心排血量监测(PICC0)技术和动脉血气分析,测定各组血流动力学参数和肺气体交换。结果:静脉注射内毒素能够诱导稳定的脓毒症幼猪模型。该模型血气分析指标p H、HCO3-、股动脉血氧分压(Pa O2)、平均动脉压(MAP)及心脏指数(CI)均较基础值明显降低(P<0.01)。NO组Pa O2及CI均较吸入前和同时点对照组明显升高(P<0.01)。NO组及对照组心率(HR)、中心静脉压(CVP)、全心舒张末容积指数(GEDI)及胸腔内血容积指数(ITBI)均无明显变化。结论:吸入NO气体可以改善脓毒症幼猪的心功能及氧合功能。

Objective To explore the changes in cardiac index and oxygenation index in sepsis piglets after nitric oxide （NO） gas inhalation. Methods A piglet model of sepsis was induced by intravenous infusion of Gram-negative bacterial endotoxin （LPS）, then the piglets were randomly divided into two groups. NO group （n=8） was administered with inhaled nitric oxide of 80ppm via volume control （VC） mechanical ventilation for one hour, while the control group （n = 4） received mechanical ventilation with VC and was observed for one hour to assess the stability of the model. The parameters of oxygenation and hemodynamics were measured by PICCO and arterial blood gas analysis every fifteen minutes for one hour. Results Injection of endotoxin induced a stable pig model of sepsis. PH, HCO3-, arterial oxygen pressure （PaO2）, mean arterial pressure （MAP） and cardiac index in this model were significantly lower the baseline values （P 〈 0.01）. Arterial oxygen pressure and cardiac index were significantly higher in N0 group than in the control group （P〈0.01）. Heart rate （HR）, central venous pressure （CVP）, global end-diastolic volume index （GEDI） and intrathoracic blood volume index （ITBI） did not significantly differ between NO group and the control group. Conclusions Inhalation of nitric oxide gas can significantly improve oxygenation and cardiac function in piglets with sepsis.