氧合氟碳液早期肺灌洗对犬重度单肺吸入伤的影响——与生理盐水肺灌洗的比较

Effect of massive bronchoalveolar lavage (MBL)with oxygenated perflurodecalin in early post-injury stage on acute severe single lung smoke inhalation injury in dogs comparing with MBL with normal saline

目的 与生理盐水肺灌洗比较 ,研究评价氧合氟碳液PFC早期肺灌洗治疗犬重度单肺吸入伤的优缺点。方法 建立犬左肺单侧急性重度烟雾吸入伤模型 ,伤后 1h对伤肺进行氧合氟碳液PFC或生理盐水大容量灌洗。观察自主呼吸 2 4h内犬双肺换气功能 ,肺病理和病理生理学变化程度 ,计算两种灌洗液的清洁效率。结果 (1)生理盐水和PFC肺灌洗均可有效清除下呼吸道 ,减轻吸入伤引起的原发性和继发性肺组织结构改变 ;(2 )生理盐水灌洗犬左肺伤后 2 4h肺功能无改善而右肺和全肺功能相对未灌洗犬有一定改善 ;(3)PFC肺灌洗清洁功能不及生理盐水 ,但灌洗犬近期肺功能显著优于生理盐水灌洗犬和吸入伤后自然演变组犬。结论 早期大容量肺灌洗可有效减少吸入伤犬肺继发性炎症反应 ,氧合氟碳液灌洗在显示近期综合疗效方面有优越性。

Objective To investigate the effect of massive bronchoalveolar lavage(MBL) with oxygenated perflurodecalin in early post injury stage on acute severe single lung smoke inhalation injury in dogs comparing with MBL with normal saline.Methods After the model of smoke inhalation injury to unilateral left lung had been performed MBL to the injured lung with 250 ml of oxygenated perflurodecalin or normal saline was achived in an hour and then the dogs were kept to breathe air freely for 24 hours. The materials washed out in two difficult lavaging liquids were checked and gas exchange function of bilateral lungs in the process were observed. After these the pathologic and biopathologic changes of the lungs specimen were checked after the process. Results (1)The effect of lung cleaning was good either BML with PFD or with normal saline for both of them had weakened the primitive and secondary pathologic changes of lung tissues effectively;(2)Gas exchange function of injured lung was not improved but that in contralateral lung and in bilateral lungs were improved in 24hours in dogs with normal saline BML. The capacity of lung cleaning of PFD lavageing was lower than normal saline lavaging but short term gas exchange function improving of bilateral lungs was better in dogs with PFD lavageing than that in dogs with normal saline lavageing. Conclusion MBL in early post injury stage could mitigate the intensity of secondary systemic inflammatory reaction and show a therapeutic validity to smoke inhalation injury . Oxygenated perflurodecalin lavaging demonstrated better effect on short term pulmonary gas exchange function improving than normal saline lavaging.