实验性急性肺损伤部分液体通气效应与剂量的关系

Dose-response relationship of partial liquid ventilation in surfactant depletion induced by acute lung injury

目的:对肺灌洗诱导的急性肺损伤家兔实施不同剂量氟碳(perfluorocarbon,PFC)的部分液体通气(partialliquidventilation,PLV),观察其疗效及剂量-效应关系。方法:14只成年健康家兔,麻醉后经气管导管用生理盐水反复肺内灌洗,直至动脉氧分压(PaO2)<13 33kPa(100mmHg)达1h,记录肺气体交换、血液动力学及呼吸动力各参数作为肺损伤(acutelunginjury,ALI)基础值。随机分为PLV组及对照组,对照组以呼吸机行常规机械通气,不给予任何治疗措施;PLV组动物于ALI后每30min气管内灌入PFC(FC3280,3M,德国)6mL·kg-1共3次,总量为18mL·kg-1。以上述呼吸参数行机械通气。最后一次灌注后继续行机械通气3h,每小时记录各参数次。结果:PLV组PaO2及动脉血氧饱和度(HbO2)在灌注第一个剂量的PFC后即显著改善,并与剂量呈相关性;PaCO2在灌注第一个PFC剂量后较ALI时显著降低,但并不随剂量的增加而继续降低。结论:以氟碳为媒介的部分液体通气可明显改善肺灌洗诱导的急性肺损伤家兔的肺氧合,并呈剂量相关性,同时呼吸动力的改善与剂量无关。

Aim: To observe the dose-response relationship of partial liquid ventilation with perfluorocarbon in rabbits with surfactant depletion induced by acute lung injury. Methods: Fourteen adult rabbits were surfactant depleted by lung lavage to a partial pressure of oxygen in arterial blood(PaO2) below 100 mmHg for one hour and randomly divided into control group and PLV group, which receive PFC(FC3280)in three intratracheal doses of 6 mL·kg^(-1)·30 min^(-1). The changes of the parameters of gas exchange, hemodynamics and of ventilation mechanism were measured before lung lavage, after lung lavage when the acute lung injury was established, and 30 min after each dose of PFC, 1 st hour, 2 nd hour, (3 th hour) after the last dose of PFC instillation. Results: Surfactant depletion from a stable acute lung injury induced by lung lavage. PaO2 in PLV group was increased significantly after first dose of PFC, and maintained continuously increasing by second and the third doses of PFC instillation. PaCO2 in PLV group was significantly decreased when compared with that in control group. PIP in PLV group was decreased after the first dose of PFC, and maintained constant after that. Conclussion: In rabbits with surfactant depletion induced by acute lung injury, partial liquid ventilation with perfluorocarbon improved the gas exchange, and the effect shows dose-dependent.