肺灌洗及外源性肺表面活性物质治疗烟雾吸入性损伤的实验研究

Experimental study on the treatment of smoke inhalation injury with lung lavage and exogenous pulmonary surfactant

为探讨肺灌洗与外源性肺表面活性物质（ＰＳ）治疗对严重烟雾吸入伤后内源性ＰＳ功能障碍和急性呼吸衰竭的防治效果，作者将重度烟雾吸入伤后Ｗｉｓｔａｒ大鼠经气管插管注入含ＰＳ的等渗盐水或等量盐水行肺灌洗，机械通气４小时，观察２４小时，检测动脉血气、肺水量、静态肺顺应性（Ｃｓｔ）、支气管肺泡灌洗液（ＢＡＬＦ）蛋白含量、ＢＡＬＦ表面张力特性和２４小时病死率等。结果显示：动物伤后立即出现严重缺氧和一氧化碳中毒。烟雾吸入组发生急性呼吸衰竭、高通透性肺水肿和ＰＳ功能障碍。烟雾吸入加灌洗加ＰＳ加机械通气组Ｃｓｔ和ＢＡＬＦ表面张力特性明显改善，氧合能力显著增强，肺水量和ＢＡＬＦ蛋白含量降低，２４小时病死率明显下降。烟雾吸入加灌洗加机械通气组也有一定疗效。作者认为，早期肺灌洗和外源性ＰＳ治疗能有效恢复烟雾吸入所致内源性ＰＳ功能抑制，改善肺功能，防止高通透性肺水肿和呼吸衰竭，降低早期病死率。

To investigate the prevention and treatment effects of lung lavage and exogenous pulmonary surfactant (PS) on endogenous surfactant system dysfunction and acute respiratory failure caused by severe smoke inhalation,Wistar rats were randomly divided into five groups: Group I, normal control; Group II, smoke inhalation; Group III, smoke+lavage+ PS+mechanical ventilation (MV); Group IV, smoke+lavage+MV; Group V, smoke+MV. The lungs were lavaged with 30ml/kg 0.9% NaCl containing 100mg/kg PS or same volume of saline via tracheal catheter at 5 min after smoke inhalation, then the animals were placed on a ventilator for 4h, and observed until 24h postinjury. The arterial blood gas levels, lung water volume, static lung compliance (Cst), total protein and albumin contents in bronchoalveolar lavage fluid (BALF), surface tension properties of BALF, and fatality rate at 24h were measured.Smoke inhalation caused a similar acute hypoxia and severe carbon monoxide poisoning immediately in all injuried groups. The animals in group II showed acute respiratory failure, serious high permeability pulmonary edema, and surfactant system dysfunction. The surface tension properties of BALF, Cst, and the oxygenation were significantly improved with lung lavage and exogenous PS treatment. The lung water volume, total protein and albumin contents in BALF were decreased dramatically in this group. The fatality rate at 24 h declined markedly only in group III. It was suggested that lung lavage and exogenous surfactant treatment trestores effectively endogenous surfactant function inhibited by smoke inhalation, improves lung function, prevents high permeability pulmonary edema and respiratory failure, and decreases the mortality in early stage after smoke inhalation injury.