肺表面活性物质与一氧化氮吸入治疗急性肺损伤效果观察

The Curative Effect of Pulmonary Surfactant and Inhaled Nitric Oxide in Acute Lung Injury

目的:探讨急性肺损伤(ALI)采用一氧化氮吸入(i NO)和肺表面活性物质(Surf)的治疗效果。方法:选取健康新西兰兔50只,随机分为Surf治疗组,i NO吸入治疗组,Surf、i NO吸入联合治疗组,无菌生理盐水腹腔注射+单纯机械通气对照组,正常组。除正常组外,其他均取标准大肠杆菌菌株腹腔注射,对ALI诱发。监测呼吸力学、血气等改变情况。结果:正常组、对照组、Surf组、i NO组、联合组在基础状态时,呼吸系统动态顺应性(Cdyn)、Pa O2/Fi O2差异无统计学意义(P>0.05)。肺损伤各组在ALI时,Cdyn和Pa O2/Fi O2差异无统计学意义(P>0.05),但相较正常组,Cydn、Pa O2/Fi O2明显降低,差异有统计学意义(P<0.01)。Surf组治疗后,氧合较i NO组、对照组有明显改善(P<0.05),但联合组氧合改善作用最显著。结论:感染性ALI时,取NO吸入,可使氧合立即改善,但肺部病理损害无法减轻,持续时间较短;取Surf应用后,肺功能、氧合可改善,对肺内Surf补偿,使Sur功能提高,肺病理损害减轻。取吸入NO和Surf联用,可使感染性ALI病情进展缓解,效果优于单用,值得临床深入研究。

Objective：To evaluate the curative effect of inhaled nitric oxide（i NO） and pulmonary surfactant（Surf） in treatment of in acute lung injury. Method：50 healthy New Zealand rabbits were randomly divided into Surf treatment groups, i NO inhalation therapy group, Surf group, i NO inhaled combination therapy group, intraperitoneal injection of sterile saline group, simple mechanical ventilation group and the normal group. In addition to the normal group, the other E. coli strains were taken standard intraperitoneal injection,induced ALI. of respiratory mechanics,blood gas and other conditions change were monitored.Result：Normal control group, Surf group, i NO group, when combined group on the basis of status, respiratory system dynamic compliance（Cdyn）,Pa O2/Fi O2 was no significant difference（P〈0.05）.ALI lung injury in each group,Cdyn and Pa O2/Fi O2 was no significant difference（P〈0.05）,but compared to the normal group,Cydn,Pa O2/Fi O2 significantly lower statistically significant（P〈0.01）.Surf group after treatment,compared with oxygenation i NO group,the control group showed a significant improvement in performance（P〈0.05）,but the combined group the most significant role in improving oxygenation.Conclusion：Septic ALI,take NO inhalation,can immediately improve oxygenation,but can not reduce the pathological damage the lungs,short duration.Surf taken after application, pulmonary function,improves oxygenation of the lungs Surf compensation Sur function enables improved lung pathology damage mitigation.Taken in combination with inhaled NO and Surf,can alleviate the progression of infectious ALI,better than alone,is worthy of further study.