控制性肺膨胀对急性肺损伤绵羊吸痰后动脉氧合的影响

Effects of sustained inflation on arterial blood oxygenation after endotracheal suctioning in sheep with Acute lung injury

目的探讨控制性肺膨胀 (SI)对急性肺损伤 (ALI)绵羊吸痰后动脉血氧合与肺机械力学的影响。方法内毒素持续静脉注射制备绵羊ALI模型 ,分为SI组与非SI组 ,SI组在吸痰后立即实施一次SI ,观察两组吸痰后动脉血氧合改变与肺机械力学改变。结果非SI组动脉血氧分压 (PaO2 )吸痰前为 1 0 9± 6 2 5kPa ,吸痰后 3min为 1 0 9± 6 2 4kPa ,较吸痰前无明显改变 ;在吸痰后 1 5min明显降低为 (9 4 9± 4 0 1 (P <0 0 5 )。SI组吸痰后PaO2较吸痰前无明显下降 (P >0 0 5 ) ;与非SI组相比 ,SI组在吸痰后 1 5minPaO2 有显著升高 (P <0 0 5 )。非SI组吸痰前静态肺顺应性 (Cst)为 2 0 6± 0 5 89ml/kPa ,在吸痰后 3min显著降低为 1 8 5± 0 4 82ml/kPa(P <0 0 5 )。SI组在吸痰前Cst为 2 0 1± 5 80ml/kPa,吸痰后 3和 1 5min显著增加至 2 5 5± 0 879ml/kPa和 2 4 2± 0 6 88ml/kPa(P <0 0 5 )。在吸痰后两组气道阻力均明显降低 (P <0 0 5 )。

Objective To investigate the effect of sustained inflation (SI) on arterial blood oxygenation after endotracheal suctioning (ETS) in sheep with Acute lung injury (ALI). Methods ALI sheep model was induced by intravenous infusion 3 g/kg lipoplysaccharide (LPS). Gas exchange and lung mechanics of the sheep group with SI and without SI was measured. Results In the group without SI, partial arterial oxygen tension (PaO 2) descended from (82.2±46.9) mmHg before ETS to (71.2±30.3) mmHg at 3 min after ETS ( P <0.05); in the group with SI, PaO 2 did not change significantly. There was significant difference between the two procedures in PaO 2 at 15 min after ETS ( P <0.05). In the group without SI, static compliance (Cst) descended significantly from(21.0±6.1) ml/cmH2O before ETS to (18.9±4.9) ml/cmH2O at 3 min after ETS( P <0.05); in the group with SI Cst increased significantly from(20.5±5.7) ml/cmH2O before ETS to (26.0±8.6)ml/cmH 2O at 3 min and (24.7±7.1) ml/cmH 2O at 15 min after ETS( P <0.05). After ETS, the resistant of airway (RAW) descended significantly ( P < 0.05 ). Conclusions Arterial hypoxygen induced by ETS can be reversed by SI.