联合应用吸入一氧化氮和肺表面活性物质治疗兔急性呼吸窘迫综合征

EFFECTS OF COMBINED INHALED NITRIC OXIDEAND PULMONARY SURFACTANT ON OLEIC ACID-INDUCEDACUTE RESPIRATORY DISTRESS SYNDROME IN RABBITS

探讨联合应用吸入一氧化氮（ＩＮＯ）和肺表面活性物质（ＰＳ）对实验性急性呼吸窘迫综合征（ＡＲＤＳ）的治疗作用。方法油酸诱发新西兰兔ＡＲＤＳ模型后，分组（ｎ＝９）进行机械通气治疗６ｈ：（１）对照组；（２）ＮＯ组（２０×１０－６）；（３）ＰＳ组（１００ｍｇ／ｋｇ）；（４）ＰＳ＋ＩＮＯ组（ＰＳＮＯ组）。于基础状态、治疗前和治疗后测定动态胸肺总顺应性（Ｃｄｙｎ）、ＰａＯ２／ＦｉＯ２、肺内静动脉分流Ｑｓ／Ｑｔ）。实验结束时测定肺灌洗液总磷脂（ＴＰＬ）、最小表面张力（γｍｉｎ），肺湿干重比（Ｗ／Ｄ）和肺泡扩张度（Ｖｖ）。结果治疗后对照组肺功能呈下降趋势，ＮＯ组Ｃｄｙｎ无变化，ＰＳ组Ｃｄｙｎ显著增加，ＮＯ组和ＰＳ组ＰａＯ２／ＦｉＯ２和Ｑｓ／Ｑｔ均较对照组明显改善（Ｐ＜０．０５），ＰＳＮＯ组Ｃｄｙｎ变化与ＰＳ组相近，但ＰａＯ２／ＦｉＯ２较ＮＯ组和ＰＳ组进一步增加（Ｐ＜０．０５），Ｑｓ／Ｑｔ进一步降低（Ｐ＜０．０５）。与对照组和ＮＯ组比较，ＰＳＮＯ组和ＰＳ组ＴＰＬ和Ｖｖ明显增加（Ｐ＜０．０１），γｍｉｎ和Ｗ／Ｄ显著降低（Ｐ＜０．０５）。结论联合应用ＩＮＯ和ＰＳ对于实验性ＡＲＤＳ具有协同治疗效果。

おURPOSE To assess the efficacy of a combined inhaled nitric oxide (INO) and intratracheal exogenous pulmonary surfactant (PS) therapy in experimental acute respiratory distress syndrome(ARDS).METHODS 36 rabbits were anaesthetized, tracheotomized and mechanically ventilated. Oleic acid (OA) was infused intravenously to induce ARDS and then allocated them equally to groups receiving: (1) neither INO nor PS (control); (2) INO 20×10-6(NO); (3) intratracheal PS 100mg/kg (PS); (4) PS and INO (PSNO), and were ventilated for another 6 hours to observe dynamic lung compliance, blood gas analysis and intrapulmonary shunting (s/t) followed by bronchoalveolar lavage (BAL) or morphometric analysis of the lungs.RESULTS Animals in the control group showed deterioration of lung function, and had the lowest survival rate. The NO group had significantly improved PaO2/FiO2 and reduced s/t (P<0.05), whereas the PS group had not only improved PaO2/FiO2 and reduced s/t comparible to the NO group, but also increased Cdyn and alveolar expansion (P<0.01), and reduced surface tension of BAL fluid (P<0.01). The PSNO group had improved Cdyn, alveolar expansion and surface tension comparible to the PS group, but showed further increased PaO2/FiO2 and decreased s/t (P<0.05).CONCLUSIONS The results suggest that a combined use of inhaled NO and exogenous PS exerts synergetic therapeutic effects on this ARDS model.