部分液体通气对兔海水淹溺型肺水肿的气体交换和病理组织学的影响

The effect of partial liquid ventilation on pulmonary tissue in rabbits with pulmonary edema following seawater drowning

目的 观察部分液体通气 (PLV)与常规机械通气 (CMV)对海水淹溺型肺水肿 (PE SWD)家兔肺组织损伤程度的影响。方法 健康成年雄性新西兰兔 2 4只 ,经气管插管注入海水制成PE SWD模型后 ,随机分为 3组 (n =8) :阳性对照组 (PE) ;常规机械通气组(CMV) ,即常规通气(CMV) +呼气末正压 (PEEP)治疗 ;部分液体通气组 (PLV) ,即肺内注入全氟萘烷 (FDC) +CMV +PEEP。治疗180min,分别观察各组治疗前后动脉血PaO2 、PaCO2 、血浆肿瘤坏死因子α(TNF α)及肺病理组织学的变化。结果 PLV组治疗后PaO2 明显改善 ,较CMV组稳定 ;肺泡腔渗出减少 ;肺水肿、肺不张等轻于CMV组 ;TNF α水平低于PE组 (P <0 0 5 ) ,但与CMV组比较差异不明显。结论 PLV可明显改善PE SWD家兔的动脉血气情况 ,减轻肺组织损伤。

Objective To observe the effect of partial liquid ventilation (PLV) and conventional mechanical ventilation(CMV) on gas exchange in lung injury due to pulmonary edema as a result of seawater drowning in rabbit. Methods Twenty-four healthy male new Zealand rabbits were randomly divided into three groups ( n =8). Pulmonary edema was produced in all rabbits by drowning in sea water. Rabbits of PE group received no treatment,that of CMV group were treated with conventional mechanical ventilation and PEEP,and that of PLV group with CMV,combined with PEEP and FDC. All rabbits were treated for 3 hours. Blood gases,TNF-αin plasma and pulmonary histopathology were determined during the experiment. Results In PLV group,PaO_2 was increased obviously,inflammatory exudate was reduced,and alveolar and interstitial edema was alleviated. The plasma level of TNF-αwas significantly lower in PLA group compared with PE group,( P <0.05),but there was no difference between PLV and CMV groups. Conclusion Pulmonary gas exchange was improved significantly during PLV in the PE-SWD rabbits,and lung injury was ameliorated.