高频振荡结合部分液体通气对兔急性肺损伤的治疗作用

High frequency oscillatory ventilation with perfluorocarbon in rabbits with acute lung injury

目的 探索高频振荡结合高氟碳化合物 (PFC)通气对急性肺损伤动物的治疗作用。方法 将 2 4只成年家兔行反复温盐水肺灌洗制成急性肺损伤 (ALI)模型 ,随机分为 4组 :常规通气(CMV)组、CMV +PFC组、高频振荡通气 (HFO)组和HFO +PFC组。每组均持续通气 2h ,分别在 30、6 0和 12 0min测定和计算血气、呼吸系统动态顺应性 (Cdyn)和肺内动静脉分流率 (Qs/Qt)。结果 CMV +PFC组与CMV组比较 ,30min时气体交换、Cdyn和Qs/Qt均有明显改善 (PaO2 12 2mmHg± 15mmHg对6 9mmHg± 8mmHg、PaCO2 2 9 1mmHg± 2 7mmHg对 47 1mmHg± 2 9mmHg、Cdyn 1 35± 0 13对0 97ml·cmH2 O-1·kg-1± 0 13ml·cmH2 O-1·kg-1、Qs/Qt 18 1± 1 1对 2 4 5± 2 9) (P <0 0 1～ 0 0 5 ) ,并持续至 12 0min。HFO +PFC组与HFO组比较 ,前者可在更短的时间内达到最佳氧合和通气效果。30min时气体交换和Qs/Qt均有显著改善 (PaO2 175mmHg± 19mmHg对 132 3mmHg± 194mmHg、PaCO2 2 6 1mmHg± 2 6mmHg对 34 9mmHg± 4 6mmHg、Qs/Qt17 1± 2 4对 19 8± 0 9) (P <0 0 5 ) ,并持续至 6 0min。结论 CMV +PFC组可显著改善急性肺损伤兔的气体交换和Cdyn。HFO +PFC组可使HFO在更短的时间内达到最佳气体交换状态。

Objective To investigate the efficacy of high frequency oscillation with perfluorocarbon (PFC) in rabbits with acute lung injury (ALI). Methods Twenty four rabbits with ALI induced by repeated saline lung lavage were randomly assigned to four groups: conventional mechanical ventilation (CMV) group,CMV+PFC group, high frequency oscillation (HFO) group and HFO+PFC group. All rabbits were ventilated for two hours. Blood gases, respiratory system dynamic compliance (Cdyn) and intrapulmonary shunt fraction (Qs/Qt) were measured and calculated at 30, 60, and 120 min during experiment. Results Compared with the CMV, statistically improvements were shown in gas exchange, Cdyn and Qs/Qt at 30 min in the CMV+PFC group [PaO 2 122 mm Hg±15 mm Hg vs. 692 mm Hg±82 mm Hg、PaCO 2 29 1 mm Hg±2 7 mm Hg vs 47 1 mm Hg±2 9 mm Hg、Cdyn (1 35±0 13) vs (0 97±0 13) ml·cm H 2O -1 ·kg -1 、Qs/Qt 18 1±1 1 vs.24 5±2 9]( P <0 01～0 05) and remained stable for two hours. Compared with HFO , HFO+PFC improved oxygenation and ventilation more rapidly than HFO did. At 30 min intervals gas exchange and Qs/Qt were significantly improved(PaO 2 174 9±18 5 vs 132 3±19 4、PaCO 2 26 1±2 6 vs 34 9±4 6, Qs/Qt 17 1±2 4 vs 19 8±0 9) ( P <0 05)and remained stable to 60 min. The same differences were seen at 60 min. Conclusion In rabbits with ALI, CMV+PFC could induce a significant improvement in gas exchange and Cdyn. HFO+PFC leads more rapidmy to reach best gas exchange and Cdyn.