高频振荡结合部分液体通气治疗急性呼吸衰竭兔的实验研究

Experimental Study of High Frequency Oscillatory Ventilation with Perfluorocarbon in Rabbits with Acute Respiratory Failure

目的探讨高频振荡通气(HFOV)结合高氟碳化合物(PFC)对重度蒸汽吸入性肺损伤导致的急性呼吸衰竭兔的呼吸功能及IL-10、IL-18的影响。方法将24只新西兰大白兔制成重度蒸汽吸入性肺损伤并急性呼吸衰竭模型,随机分为常规机械通气(CMV)组、HFOV组和HFOV+PFC组,分别在治疗后1、2、3、4h取动脉血行血气分析,治疗4h后抽血处死动物,ELISA法测定血清中IL-10、IL-18水平,右肺中叶取标本,行病理学检查。结果3组兔伤后PaO2均降至60mmHg(1mmHg=0.133kPa)以下,各组伤前、伤后比较均有显著性差异(P<0.01),组间比较差异无统计学意义(P>0.05)。3组兔伤后PaCO2均升高,pH值均降低,各组伤前、伤后比较有显著性差异(P<0.01),组间比较无差异(P>0.05)。治疗1h时3组的PaO2均有上升,HFOV+PFC组上升最为明显,HFOV+PFC组明显高于HFOV组(P<0.01),HFOV组明显高于CMV组(P<0.01)。治疗4h后3组PaO2均有所改善,HFOV+PFC组高于相应时相HFOV组(P<0.01),HFOV组高于相应时相CMV组(P<0.01)。治疗4h后3组兔pH值、PaCO2与致伤后比较差异无统计学意义(P>0.05);血清中IL-10水平:HFOV+PFC组高于HFOV组(P<0.01),HFOV组高于CMV组(P<0.01);血清中IL-18水平:HFOV+PFC组低于HFOV组(P<0.01),HFOV组低于CMV组(P<0.01);肺组织病理学检查发现HFOV组的损伤程度较CMV组减轻,HFOV+PFC组损伤最轻,CMV组损伤最重。结论HFOV结合PFC可显著改善蒸汽吸入性损伤导致的急性呼吸衰竭兔的PaO2,并能在更短的时间内达到最佳气体交换状态,改善呼吸功能。还可提高血清中IL-10水平,降低血清中IL-18水平,从而减轻肺部炎症反应,减轻肺损伤,是治疗急性呼吸衰竭兔较好的方法。

Objective To investigate the efficacy of high frequency oscillation veil （HFOV） with perfluorocarbon（PFC） in rabbits with acute respiratory failure induced by water vapour inhalation injury and its influence on level of interleukin-10 （IL-10） and interleukin-18 （IL-18）. Methods Twenty-four New Zealand rabbits with acute respiratory failure induced by water vapour inhalation injury were randomly assigned into three groups： conventional mechanical ventilation （CMV） group,high frequency oscillation ventilation （HFOV）group and HFOV＋ PFC group. All rabbits were ventilated for four hours, Blood gases were measured at 1,2,3,4 hour during experiment. In 4 hours later the blood samples were colletcted to measure the level of interleukin-10（IL-10） and interleukin-18 （IL-18） by ELISA and the part of the middle lobe of right lung was for histological observation. Results After acute respiratory failure established PaO2 in the three groups decreased below 60 mm Hg（1 mm Hg=0. 133 kPa）（P〈0. 131） ,and inergroup differences were not found（P）0.05）. PaCO2 in the three groups increased and pH decreased（P〈0.01） ,and intergroup differences were not found（P〉0.05）. PaO2 in the three treatment groups had increased at one hour after treatment and that in HFOV＋PFC group was higher than HFOV group （P〈0. 01）. The PaO2 in HFOV group was higher than CMV group （P〈0.01）. After four hours,PaO2 of three groups increased and that in HFOV＋PFC group was higher than HFOV group at the same time（P〈0.01）. PaO2 in HFOV group was higher than CMV group at the same time（P〈0.01）. After four hours,differences of PaCO2 and pH were not found （P）0.05）. The levels of IL-10： HFOV＋PFC group was higher than HFOV group（P〈0.01）, HFOV group was higher than CMV group（P〈0.01）;levels of IL-18： HFOV＋PFC group was lower than HFOV group（P〈0.01）, HFOV group was lower than CMV group（P〈0.01）. Histological injury score was the lowest in HFOV＋PFC group and the highest in CMV group. Conclusion HFOV with PFC could be better improve arterial oxygenation in less time,and increase IL-10,decrease IL-18,alleviate pulmonary edema and injury,which may be a optimal method for the treatment of rabbits with acute respiratory failure caused by water vapour inhalation injury.