肺动脉-左心房无泵肺辅助联合低潮气量机械通气治疗猪急性肺损伤的实验研究

Experimental study of pulmonary artery-left atrium pumpless pulmonary assist combined with low tidal volume mechanical ventilation in piglets with acute lung injury

目的::观察肺动脉-左心房无泵肺辅助联合低潮气量机械通气对急性肺损伤的治疗效果。方法:健康中华小型猪12只,用油酸诱导建立急性肺损伤模型后,随机分两组,每组6只:低潮气量机械通气组(LM组);低潮气量机械通气+肺动脉-左心房无泵肺辅助组(LMP组)。观察两组呼吸、循环系统指标在不同时间点的变化。外科操作后稳定30分钟,定义为T1,后每隔1小时,分别为T2、T3、T4和T5。结果:两组间幼猪在注射油酸前各项指标均无明显差异,但在注射油酸后T2时间点各项指标均有明显变化(P<0.05),其中p H值、氧分压、动脉血压明显降低,二氧化碳分压、气道压及中心静脉压明显升高,测氧合指数提示模型制作成功。在无泵肺辅助开始后,与LM组相比,LMP组动脉血PH值、氧分压、二氧化碳分压、血压在T3、T4、T5时间点均有明显改善(P<0.05);中心静脉压在T3、T5时间点有明显差异(P<0.05);LMP组在T5时气道压明显低于LM组(P<0.05)。结论:肺动脉-左心房无泵肺辅助联合低潮气量保护机械通气能够维持循环稳定并且有效改善实验猪急性肺损伤后的顽固性低氧和二氧化碳潴留。

Objective： To investigate the therapeutic effect of pulmonary artery-left atrium pumpless pulmonary assist combined with low tidal volume mechanical ventilation on acute lung injury. Methods： Acute lung injury models were made through injection of oleic acid in 12 piglets,which were randomly divided into two groups after acute lung injury： low tidal volume mechanical ventilation（ LM group,n = 6）; low tidal volume mechanical ventilation ＋ pulmonary artery-left atrium pumpless pulmonary assist（ LMP group,n = 6）. Respiratory and circulatory parameters were monitored at different time point,defined 30 min after surgical operation and hemodynamic ally stable as T1,and every 1 h thereafter as T2,T3,T4 and T5）. Results： The baseline parameters between the two groups were comparable,but after the injection of oleic acid,the parameters changed significantly（ P〈0. 05） at the time of T2 point. The p H value,arterial oxygen partial pressure,arterial blood pressure decreased significantly. Meanwhile,carbon dioxide partial pressure,airway pressure and central venous pressure increased significantly. The results of oxygenation index indicated that the model of acute lung injury was established successfully. After the pulmonary artery-left atrium pumpless pulmonary assist,the PH,partial pressure of oxygen,carbon dioxide partial pressure and arterial blood pressure of LMP group were significantly improved compared with LM group at T3,T4 and T5 point（ P〈0. 05）. Central venous pressure has significant differences between the two groups at T3 and T5 point（ P〈0. 05）. LMP group has a lower airway pressure than the LM group at T5 point（ P〈0. 05）. Conclusion： The pulmonary artery-left atrium pumpless pulmonary assist combined with low tidal volume lung ventilation can provide a stable circulation and improve refractory hypoxia and hypercapnia of piglets with acute lung injury.