犬急性重度烟雾吸入伤后早期大容量肺灌洗的安全性研究

Study on the safety of massive lung lavage to dogs after acute serious smoke inhalation

目的 探讨急性烟雾吸入伤犬早期大容量肺灌洗的安全控制问题。方法 1 6只杂种犬随机分成 3组 :A组 5只 ,烟雾吸入伤后单纯控制呼吸支持 ;B组 6只 ,吸入伤后 1h采用特殊的通气方式维持肺换气的同时 ,在纤支镜引导下左肺大容量肺灌洗。间隔 30min行右肺灌洗 ;C组 5只 ,双肺灌洗间隔时间 4h。比较 3组犬呼吸和循环系统的稳定程度。结果 每侧肺灌注总量 2 5 0ml,两组犬血流动力学数据变化趋势基本相同 :吸入伤对循环有一定的负性作用 ,而肺灌洗的影响较小 ;灌注中均未出现严重的心律失常。单肺灌注操作时间 1 5min左右 ,简单负压吸引后单肺灌注液存留量 1 0 0～ 1 40ml。两组肺灌洗犬灌注中、后控制呼吸至伤后 1 0h ,PaO2 均不低于 9.33kPa(FiO2 =0 .4)。两肺灌注间隔 4h犬肺换气功能优于间隔 30min者而不及不灌洗犬。

Objective To explore the feasibility and safety of massive lung lavage to dogs in the early stage after acute serious smoke inhalation. Methods A total of 16 dogs were inflicted with smoke inhaled injury and then divided into group A ( n =5) without lung lavage, group B ( n =6) in which left lung lavage was followed by lavage on the right 30 min later, and group C ( n =5) in which the interval of the lavages on the left and right lung was 4 h. Massive lung lavage was carried out in 1 h after the injury under the guiding fiberoptic bronchoscopy and a special ventilation jet was served to supply enough oxygen to the dogs. The stability of pulmonary function and blood circulation were observed at different time points in every group. Results The average operating time of unilateral lung lavage was about 15 minuted and the liquid volume left in every lung after operation was from 100 ml to 140 ml when the total lavaging volume was kept in 250 ml. The changes of hemodynamic parameters were identical in Group B and Group C. Inhalation injury had certain negative effect while lung lavage almost had no effect on the blood circulation of the animals in 2 lavage groups. No serious cardiac arrythemia was found in them during the lavaging. Pulmonary function in Group C was better than that in Group B but worse than that in Group A. In the 2 lavaging groups, PaO 2 remained higher than 9.33 kPa(FiO 2=0.4)during and after the lavaging. Conclusion The ventilation mode and the lavage method introduced here ensure the safety of massive lung lavage in dogs with acute smoke serious inhalation injury.