急性呼吸窘迫综合征病人肺泡表面活性物质的变化

Changes of plumonary surfactant in patients with acute respiratory distress syndrome

目的 研究患急性呼吸窘迫综合征 (ARDS)时病人肺泡表面活性物质的变化。方法 应用薄层色谱法测定ARDS早期病人 ( 5例 )和晚期病人 ( 5例 )肺泡灌洗液中肺泡表面活性物质 ,并和正常对照组 ( 5例 )作比较。结果 肺泡表面活性物质的含量在对照组、早期组、晚期组分别为6 7 6± 7 2、44 0± 7 3、31 3± 6 5 μg/ml肺灌洗液 ,呈递减改变。肺泡表面活性物质主要活性成份磷脂酰胆碱、磷脂酰甘油和二磷脂酰甘油的百分比在ARDS早期升高 ,分别达 5 6 2 %± 2 8%、9 2 %±1 5 %和 2 9%± 0 7%。在ARDS晚期 ,上述三种活性成份分别降至 39 7%± 5 2 %、5 6 %± 0 7%和 2 6 %± 0 6 %。结论 ARDS病人随着病情的进展加重 ,其肺泡表面活性物质的含量和主要活性成份逐渐减少。提示若使用外源性肺泡表面活性物质防治ARDS ,不仅要在数量上补足 ,而且需要恢复活性成份的比例 。

Objective To study the changes of pulmonary surfactant in patients with acute respiratory distress syndrome(ARDS).Methods By means of thin layer chromatography, the pulmonary surfactant in lavage of patients lungs was measured in early ARDS group (5 cases),late ARDS group(5 cases) and control group(5 cases).Results The contents of pulmonary surfactant decreased with the development of ARDS.They were 67 6±7 2,44 0±7 3 and 31 3±6 5μg/ml lung lavage in control group,early group and late group respectively.The percentages of three mian active components of pulmonary surfactant were markedly higher during early ARDS.Phosphatidylcholine,phosphatidylglycerol and diphosphatidylglycerol reached to 56 0%±2 8%,9 2%±1 5% and 2 9%±0 7% respectively.During late ARDS,the percentages of three mian active components above were significantly lowered to 39 7%±5 2%,5 6%±0 7% and 2 6%±0 6% respectively.Conclusions The contents and three mian active components of pulmonary surfactant decreases with the development of ARDS.Therefore,if exogenous pulmonary surfactant was used to prevent and treat ARDS,it is suggested that satisfactory curative effects should not be achieved except the supplemented contents of pulmonary surfactant is large enouph and the percentages of mian active components are properly.