大剂量猪肺表面活性物质对盐酸吸入性肺损伤家兔血气及肺顺应性的影响

LARGE DOSE PULMONARY SURFACTANT IMPROVE BLOOD GASES AND LUNG COMPLIANCE IN RABBIT LUNG INJURY INDUCED BY ASPIRATION OF HYDROCHLORIC ACID

目的探讨大剂量外源性ＰＳ对家兔盐酸吸入性肺损伤的治疗作用。方法健康家兔２０只，气管内注入盐酸复制盐酸吸入肺损伤模型，分为２组：Ａ组（ｎ＝１０）为ＰＳ治疗组，气管内注入３７℃ＰＳ１００ｍｇ／ｋｇ；Ｂ组：（ｎ＝１０）为治疗对照组，气管内注入同等体积的生理盐水，观察ＰＳ对动脉血气和肺顺应性的影响。另设Ｃ组（ｎ＝８），在Ａ、Ｂ组动物模型复制及治疗相应时间气管内注入同等体积的生理盐水作为ＰＳ疗效的对照。结果Ａ组ＰＳ治疗后各时间点ＰａＯ２高于Ｂ组（Ｐ＜０．０５），但多数时间点仍低于Ｃ组（Ｐ＜０．０５）；Ａ组各时间ＰａＣＯ２均低于Ｂ组（Ｐ＜０．０１），治疗早期高于Ｃ组（Ｐ＜０．０５）；Ａ组动脉血ｐＨ值均低于Ｂ组，但Ｐ＞０．０５，与Ｃ组相比无差异（Ｐ＞０．０５）；Ａ组肺动、静态顺应性均优于Ｂ组（Ｐ＜０．０５），但仍低于Ｃ组（Ｐ＜０．０１）。结论大剂量猪肺表面活性物质可以明显地提高ＰａＯ２，降低ＰａＣＯ２，并且阻止动脉血ｐＨ的进一步下降，改善肺动、静态顺应性，对家兔盐酸吸入肺损伤具有治疗作用。

Objective To observe the effect of large dose pulmonary surfactant (PS) on rabbit lung injury induced by aspiration of hydrochloric acid.Methods Rabbit lung injury models were developed by aspiration of hydrochloric acid and divided into 2 groups. Group A ( n =10) were treated with PS, while group B ( n =10, as the therapy control) was treated with normal saline. The effects of PS were assessed by determining blood gases and lung compliance .The results were also compared with those in group C, a blank control ( n =8), in which normal saline was instilled instead of hydrochloric acid. Results The PaO 2 values were higher in group A than in group B ( P <0.05),but most of them were lower than in group C ( P <0.05). The PaCO 2 in group A were lower than in group B ( P <0.01), but remained to be higher than in group C ( P <0.05) in the first time of PS treatment. The arterial blood pH in group A were higher than in group B (but P >0.05) and lower than in group C ( P <0.05);The dynamic and static lung compliance were better in group A than in group B ( P < 0.05) ,but not as good as in group C ( P <0.01).Conclusions Large dose PS can lower PaCO 2 and improve PaO 2, dynamic and static lung compliance, so it has benefits in treatment of lung injury induced by aspiration of hydrochloric acid.