复方药物支气管肺泡灌洗对蒸气吸入伤犬呼吸循环功能的影响

Effects of bronchoalveolar lavage with compound drugs on cardiopulmonary function in dogs after steam inhalation injury

目的 :探讨吸入性损伤的治疗方法 ,研究小剂量复方药物支气管肺泡灌洗 (BAL )对蒸气吸入伤犬呼吸、循环功能的影响。方法 :犬蒸气吸入致伤 4小时后 ,将纤维支气管镜楔入 3～ 4级肺叶支气管管口进行小剂量药物 BAL。结果 :BAL 后 30、6 0和 90分钟的吸气时间 (TI)、呼气相气道阻力 (RE)均显著低于基础对照值(P<0 .0 5或 P<0 .0 1) ,呼吸频率 (RR)、每分通气量 (VE)和心排血量均显著高于基础对照值 (P均 <0 .0 5 ) ;BAL 后 30～ 6 0分钟的呼气流率峰值 (VEmax)和平均呼气流率 (VE)均显著高于基础对照值 (P均 <0 .0 5 ) ,肺动脉压 (PAP)则显著低于基础对照值 (P均 <0 .0 5 ) ;BAL后 30分钟的 Pa O2 和中心静脉压 (CVP)均显著低于基础对照值 (P均 <0 .0 5 ) ,但随后逐渐恢复至接近基础对照值水平。结论 :小剂量复方药物 BAL能够缓解气道阻塞 ,降低气道阻力 ,改善肺通气 ,同时降低肺血管阻力 ,增加组织灌流。

Objective:To investigate effects of bronchoalveolar lavage (BAL) with compound drugs on cardiopulmonary function in dogs after steam inhalation injury,and to seek potential measures for treating inhalation injury.Methods:With the aid of bronchoscopy controlled volume BAL containing compound drugs was performed to lavage tertiary and quarterly branches of bronchi at 4 hours after steam inhalation injury.Results:At 30,60,90 minutes postBAL,inspiratory time (T I) and expiratory airway resistance (R E) were markedly lower than those of preBAL ( P <0 05 or P <0 01),and respiratory rate (RR),minute ventilation volume (V E) and cardiac output (CO) were markedly higher than those of preBAL (all P <0 05).The peak expiratory flow volume ( Emax ) and mean expiratory flow volume ( E) at 30 to 60 minutes postBAL were obviously increased,while pulmonary arterial pressure (PAP) was significantly declined compared with preBAL (all P <0 05).PaO 2 and central venous pressure (CVP) at 30 minutes postBAL were remarkably reduced as compared to preBAL (both P <0 05),and then both of them gradually elevated to baseline values.Conclusions:Controlled volume BAL with compound drugs can relief airway obstruction,lower airway resistance and improve pulmonary ventilation,and also reduce pulmonary vascular resistance and increase tissue perfusion.