肺泡灌洗表面活性物质在急性呼吸窘迫综合征治疗中的价值

Valuation of Bronchoalveolar Lavage with Pulmonary Surfactant for Acute Respiratory Distress Syndrome

目的探讨肺泡灌洗表面活性物质在急性呼吸窘迫综合征(ARDS)综合救治中的价值。方法应用高效薄层色谱法测定ARDS病人(15例)肺泡灌洗表面活性物质前及24 h后肺泡灌洗液中肺泡表面活性物质,并与正常对照组(25例)做比较。并于灌洗前及以后24 h内连续观察ARDS患者心率、血压、经皮血氧饱和度(Tc SaO2),每6 h采动脉血进行血气分析,调整并记录呼吸机相关参数。结果磷脂总量没有明显变化,而蛋白总量在治疗前后较对照组有明显增加(P<0.01);与对照组相比ARDS组治疗前磷脂酰甘油(PG)、磷脂酰胆碱(PC)、溶血磷脂酰胆碱(LPC)下降,磷脂酰肌醇(PI)、磷脂酰乙醇胺(PE)、神经鞘磷脂(SPH)比例升高;与治疗前比较,治疗后除PC、PG明显升高外(P<0.05),其他指标无明显变化(P均>0.05)。肺泡表面肺泡灌洗补充肺泡表面活性物质后6 h内PaO2/FiO2明显改善(P<0.05),12h达高峰(P<0.01),以后逐渐下降。结论 ARDS时,肺泡表面活性物质的含量与主要活性成分减少。肺泡灌洗补充肺泡表面活性物质后能够明显缓解临床症状,改善氧合功能,但持续时间相对较短,不超过24 h。量效关系尚需进一步探讨。

Objective To explore the value of Bronchoalveolar lavage with pulmonary surfactant in patients with acute respiratory distress syndrome（ARDS）.Methods By means of high-performance thin-layer chromatography,the pulmonary surfactant in Bronchoalveolar lavage fluid of patients was analyzed from ARDS group before treatment,ARDS group after 24 h treatment and control group.Blood pressure,heart rate,respiratory rate,Tc SaO2,arterial blood gas and ventilated parameters were recorded before lavage,6 h,12 h,18 h and 24 h.Results Total phospholipid did not differ between any category and controls,whereas total protein increased approximately in before treatment and in after treatment compared with controls（P0.01）.The phospholipid profiles showed a significant reduction in the relative content of phosphatidylcholine（PC）、phosphatidylglycerol（PG） and lysophosphatidycholine（LPC）in before treatment compared with controls;After treatment,there was a significant increase of PC、PG（P0.05）,but the others were no significant change（P0.05）.PaO2 and PaO2/FiO2 after bronchoalveolar lavage dramatically improved in 6 h（P0.05）,the significant improvement in PaO2 and PaO2/FiO2 was observed at the 12 h（P0.01）.Conclusions The content and main active components of pulmonary surfactant should decrease with the development of ARDS.Brochoalveolar lavage administration of pulmonary surfactant may immediately improve the oxygenation index（PaO2/FiO2） on acute respiratory distress syndrome,but the improvement must not exceed 24 h.But its indications and correct dose in clinical use should be studied further.