部分液体通气结合吸入NO对实验性急性肺损伤的疗效

The effect of combining partial liquid ventilation with nitric oxide on the animal model of acute lung injury

目的:评价以氟碳(PFC)为媒介的部分液体通气(PLV)结合吸入NO对急性肺损伤(ALI)动物肺气体交换和血液动力学的影响。方法:16只2 5～30kg的雌性健康家猪在麻醉后经气管导管以生理盐水反复肺内灌洗,直到动脉氧分压(PaO2 ) <13 3kPa达1h ,成为急性肺损伤模型,随机分为PLV组和对照组。对照组行常规机械通气2h ;PLV组经气管导管内灌以30mL/kgPFC(FC -77) ,2h后吸入体积分数为10 - 5NO观察30min ,然后停止吸入NO观察30min。记录不同时段肺气体交换和血液动力学参数。结果:PLV组PFC治疗1h ,动脉氧分压(PaO2 )与ALI时比较显著升高(P <0 0 5 ) ,平均肺动脉压(MPAP)显著升高(P <0 0 5 ) ;吸入NO与停止吸入NO比较,PaO2 无显著性升高(P >0 0 5 ) ,同时,Qs/Qt和MPAP亦无显著性降低(P >0 0 5 )。结论:PLV结合吸入NO与单独PLV比较,不能进一步降低急性肺损伤动物的肺动脉高压和肺内分流。

Aim: To assess the effect of combining partial liquid ventilation (PLV) with nitric oxide (NO) inhalation on gas exchange and hemodynamics in acute lung injury(ALI). Methods: 12 female healthy piglets weighting 25～30 kg were induced by lung lavage to a partial pressure of oxygen in arterial blood (PaO_2) below 13.3 kPa for one hour and randomly divided into control group and PLV group. Conventional mechanical ventilaton (CMV) was administered in control group; The piglets in PLV group received FC-77 in a intratracheal doses of 30 mL/kg. Two hours later 10^(-5) NO were administered together for 30 min each(ON-phase), interrupted by 30 min without NO inhalation(OFF-phase). Changes due to NO were calculated as the difference between the ON-phase values and the mean of the OFF-phase values. Results: PaO_2 significantly decreased in control group, and surfactant that in ALI stage depletion by lung lavage induced a stable acute lung injury. In PLV group following PLV 1 h, PaO_2 significantly increased than the ALI values, Qs/Qt significantly lower and MPAP significantly higher. Subsequent inhalation of NO led to a improvement in PaO_2, but the increase have no significantly difference; Qs/Qt and MPAP decreased during in inhalation of NO (ON-phase), but the both have no significantly difference than OFF-phase eithes. Conclusion: The combinbation of PLV with NO can't significantly decreased Qs/Qt and MPAP , and (can't) increase oxygenation eithes than PLV alone in the animals of acute lung injury.