HFOV联合PLV对蒸汽吸入性损伤兔呼吸、循环功能及肺组织学的影响

Effect of high frequency oscillatory ventilation and its combination with partial liquid ventilation on respiration,circulation function and lung histology in rabbit model with acute respiratory failure induced by steam inhalation injury

目的寻找治疗蒸汽吸入性损伤的合理机械通气方式。方法将32只制成重度蒸气吸入性损伤兔模型随机分为四组各8只,分别行常频机械通气(CMV),CMV+部分液体通气(PLV),高频振荡通气(HFOV)及HFOV+PLV,分别于治疗后0.5、1.5、2.53、.5 h取动脉血行血气分析;通气治疗4 h后处死动物,右肺中叶取4个不同部位(依赖区和非依赖区)标本,行病理学检查。结果各组PaO2在通气治疗0.5 h后均明显上升,通气治疗3.5 h内维持较高水平,HFOV组和HFOV+PLV组各时间点PaO2均分别高于CMV组和CMV+PLV组,CMV+PLV组1.5、2.5 h的PaO2高于CMV组,HFOV+PLV组3.5 h的PaO2高于HFOV组;各组不同时点PaCO2、心率、平均动脉压均无明显差异;肺组织病理学检查发现HFOV+PLV组损伤最轻,CMV组损伤最重。结论HFOV联合PLV能提高蒸汽吸入性损伤兔的氧合水平,减轻肺损伤。

Objective To search feasible mechanical ventilation for steam inhalation injury. Method Thirty-two New Zealand rabbits were randomly divided into four groups after acute respiratory failure models caused by severe steam inhalation injury were established. Then they were ventilated by CMV, HFOV, CMV ＋ PLV or HFOV ＋ PLV, respectively. Femoral arterial blood samples were obtained respectively at 0. 5,1.5,2.5,3.5 h treatment timepoints for blood gas examination. Tbe middle lobe in the right lung were excised 4 h after the treatment for histological sections. Results PaO2 in the four groups all decreased and PaO2 of postinjury had statistical significance compared with pre-injury at the same group（ P 〈 0.01 ）. PaO2 in the four groups had increased since 0.5 h treatment timepoint, and values of PaO2 sustained continuously within 3.5 h treatment time. PaO2 ,PaO2/FiO2 in the HFOV and HFOV ＋ PLV groups were higher than the corresponding data in CMV and CMV ＋ PLV groups respectively（ P 〈 0.05, 0.01） .PaO2 in the CMV＋ PLV group at 1.5 h and 2.5 h treatment timepoint and PaO2 in HFOV ＋ PLV group at 3.5 h treatment timepoints showed significant advantages over the data in the corresponding non-PLV groups at the same timepoints（ P 〈 0. 05, P 〈 0. 01 ）. The PaCO2 had no significant difference in the four groups at different treatment timepoints （ P 〉 0.05）. （E） The [ （W-D）/ W] of the lowest lobe of the fight lung between CMV, HFOV, CMV ＋ PLV or HFOV ＋ PLV had no difference（ P 〉 0. 05 ）. Histological injury score found the HFOV groups were more alleviated than the CMV group, the lowest in the HFOV ＋ PLV group and the highest in the CMV group. Conclusion HFOV combined with PLV can improve arterial oxygenation, alleviate pulmonary edema and injury, which may be an optimal method for the treatment of inhalation injury.