全氟化碳雾化吸入对急性呼吸窘迫综合征猪气体交换、呼吸力学和血流动力学的影响

Effects of aerosolized perfluorocarbon on gas exchange,respiratory mechanics and hemodynamics in a swine model of acute respiratory distress syndrome

目的探讨全氟化碳(PFC)雾化吸入对急性呼吸窘迫综合征(ARDS)猪气体交换、呼吸力学和血流动力学的影响。方法16只通过气管内吸入十六烷磺基丁二酸钠(DTG)制作的ARDS模型猪随机分为PFC治疗组和对照组。PFC治疗组在常规机械通气基础上,连接雾化器,以纯氧(氧流速3L/min)作为驱动气流推动雾化PFC治疗2h(7～8ml·kg-1·h-1);对照组在常规机械通气基础上,连接雾化器单独给予纯氧治疗2h(氧流速3L/min),在治疗期间每间隔15min测定动脉血气、血压、心率及平台压、顺应性、呼出潮气量和内源性呼气末正压(PEEPi),观察两组动物气体交换、呼吸力学和血流动力学参数的变化。结果DTG气管内吸入1h后,PFC治疗组动脉血氧分压(PaO2)从(377±55)mmHg(1mmHg=0.133kPa)下降至(56±13)mmHg[吸入气氧浓度(FiO2)100%],对照组PaO2从(383±53)mmHg下降至(49±12)mmHg(FiO2100%);PFC治疗组顺应性从(3.7±1.0)ml/cmH2O下降至(1.5±0.4)ml/cmH2O,对照组顺应性从(3.8±0.7)ml/cmH2O下降至(1.4±0.4)ml/cmH2O。PFC治疗2h后PFC治疗组PaO2上升至(189±133)mmHg,顺应性改善至(4.1±1.4)ml/cmH2O,呼出潮气量增加至(74.5±16.9)ml;对照组PaO2上升至(83±51)mmHg,顺应性改善至(2.8±1.8)ml/cmH2O,呼出潮气量增加至(50.1±4.1)ml;两组比较差异均有统计学意义(P均<0.05)。两组动物pH值、心率、血压、平台压、PEEPi和动脉血二氧化碳分压(PaCO2)比较差异均无统计学意义(P均>0.05)。结论PFC雾化吸入能明显改善ARDS家猪的氧合,提高损伤肺的顺应性,增加呼出潮气量。

Objective To investigate the effects of aerosolized perfluorocarbon （PFC） on gas exchanges,respiratory mechanics and hemodynamics in a swine model of acute respiratory distress syndrome （ARDS）. Methods ARDS was induced by intratracheal instillation of detergent in 16 pigles,and the animals were then randomly assigned to a PFC treated group （ n = 8 ） and a control group （ n = 8）. Animals of the control group were gas-ventilated with 100% O2 （3 L/min）,while those of the PFC treated group received an additional continuous aerosolized PFC at 7 - 8 ml · kg^-1 · h ^-1. Blood gases, average artery pressure, heart rate, platform pressure, compliance, expiratory tidal volume and intrinsic positive end- expiratory pressure（PEEPi） were measured per 15 minutes. Results Detergent instillation resulted in a marked decrease in arterial oxygen pressure（ PaO2 ） within 60 min, from （ 383 ± 53 ）mm Hg（ 1 mm Hg = 0. 133 kPa） to （49 ± 12）mm Hg in the control group[fraction of inspired oxygen（ FiO2 ） 100% ] ,and from （377 ±55）ram Hg to （56 ± 13）ram Hg in the PFC group（FiO2 100% ）. After 2 h treatment,PaO2 was increased from （49 ± 12） mm Hg to （ 83 ± 51 ）mm Hg in the control group, compliance from （ 1.4 ± 0. 4 ） ml/cm H2O to （2.8 ±1.8）ml/cm H2O,and expiratory tidal volume from （30.8 ±5.5）ml to （50. 1 ±4. 1） ml in the control group;PaO2 from （56 ± 13 ）mm Hg to （189 ± 133 ）mm Hg, compliance from （1.5 ± 0.4 ） ml/cm H2O to （4. 1 ± 1.4）ml/cm H2O, and expiratory tidal volume from （30. 8 ± 3.3 ）ml to （74. 5 ± 16. 9）ml in the PFC group（ all P 〈 0. 05 ）. There were no significant differences between groups in arterial carbon dioxide pressure （ PaCO2 ）, pH values, blood pressure, heart rates, plat pressure and PEEPi during treatment（ all P 〉 0.05）. Conclusion It is suggested that aerosolized PFC increases arterial oxygenation, comoliance, and expiratory tidal volume in extended detergent-induced ARDS.