利多卡因-肺表面活性物质混合液对洗肺鼠呼吸衰竭的作用

Effects of lidocaine-pulmonary surfactant mixture on respiratory failure induced by lung lavage in rats

目的 探讨利多卡因 (Li) 肺表面活性物质 (PS)混合液对洗肺鼠呼吸衰竭的作用。方法 2 8只Wistar大鼠戊巴比妥钠腹腔内注射麻醉后 ,经气管切开孔插入导管行人工呼吸 ,吸气峰压(Ppeak)定为 1 4 7kPa ,吸呼比为 1∶1。将Ppeak及呼气末正压 (PEEP)分别调至 1 96kPa和 0 4 9kPa后 ,对所有动物行全肺灌洗 (生理盐水 3 7℃ ,4 0ml/kg) 8～ 10次。当动脉血氧分压 (PaO2 )降至 12kPa以下时 ,将动物随机分成四组 ,每组 7只。A组 :气管内注入Li( 2 5mg ,0 5ml) ;B组 :气管内注入PS( 2 5mg ,0 5ml) ;C组 :气管内注入PS( 2 5mg)与Li( 2 5mg)的混合液 0 5ml;D组 :气管内注入生理盐水 0 5ml。 12 0分钟后撤离PEEP ,并将Ppeak调至 1 4 7kPa ,测定动脉血气值、乳酸盐浓度及潮气量。结果 所有动物PaO2 经灌洗后由 5 5 0 7kPa降至 9 4 7kPa(P <0 0 5 )。治疗后A、B、C组的PaO2 均明显升高 (与灌洗后比较 ,P <0 0 5 ) ,以B、C组的升高显著 (恢复至灌洗前水平 ) ,但D组始终保持在8 8kPa以下。撤离PEEP后 ,A、B组PaO2 降至 18 8kPa以下 ,C组则一直维持在治疗后水平 (与其它三组比较 ,P <0 0 5 )。撤离PEEP后C组的乳酸盐浓度均低于其他三组 ,而平均动脉压明显高于其他三组。结论 Li PS混合液能改善洗肺鼠的呼?

Objective To evaluate the effect of lidocaine pulmonary surfactant (Li PS)mixture on respiratory failure induced by lung lavage in rats.Methods Twenty eight Wistar rats were anesthetized with intraperitoneal pentobarbital sodium and ventilated with the inspiratory peak pressure(Ppeak) at 1 47kPa and I∶E at 1∶1 following intubation through tracheotomy.In all rats, whole lung lavage was performed with normal saline(37℃,40mg/kg)for 8 10 times after Ppeak and PEEP were adjusted to 1 96kPa and 0 49kPa respectively.The rats were randomly divided into four groups after PaO 2 decreased to less than 12kPa.In group A( n= 7),lidocaine(2 5mg,0 5ml) was injected intratracheally.In group B( n= 7),PS(25mg,0 5ml) was injected.In group C( n= 7),PS(25mg) with lidocaine(2 5mg)0 5ml was injected;In group D( n= 7),normal saline 0 5ml was injected.After treatment for 120min,PEEP and Ppeak were gradually adjusted to 0kPa and 1 47kPa respectively.The arterial blood gases,lactate concentration,and tidal volume were measured.Results PaO 2 decreased significantly from 55 07kPa to 9 47kPa after lung lavage in four groups( P< 0 05).After treatment,PaO 2 in group A,B,C increased significantly compared with that after lung lavage,( P< 0 05),especially in group B and C,the PaO 2 reconverted to the baseline.In group D,however,the PaO 2 was still less than 8 8kPa.After PEEP was adjusted to 0kPa,PaO 2 decreased significantlyin group A and B.In group C,however,PaO 2 was kept at a high level compared with that in the other 3groups( P< 0 05).Lactate concentration was lower and mean arterial pressure was higher in group C than those in the other 3 groups after PEEP was taken off.Conclusion Intratracheal administration of lidocaine together with PS not only can reverse hypoxemia and maintain the respiratory function under low airway pressure without PEEP after respiratory failure induced by lung lavage,but also can improve microcirculation and tissue oxygen metabolism.