摘要
目的观察肺泡表面活性物质（PS）、肺泡复张手法（RM）及两者联合治疗ARDS的疗效。方法健康新西兰长耳白兔28只，反复温盐水肺泡灌洗建立ARDS动物模型，行容积控制通气，通气稳定后按随机数字表法分为对照组、PS组、RM组及PS＋RM组，每组7只，分别气管内注入安慰剂、外源性PS、实施RM或PS联合RM治疗，观察动脉血气及呼吸力学指标的变化。处理后4h处死动物，行病理组织学检查评价肺损伤程度。结果（1）对照组、PS组、RM组和PS＋RM组的PaO2分别为（74±15）、（234±42）、（231±17）和（253±52）mmHg（1mmHg=0．133kPa），PS、RM和PS＋RM3组均高于对照组（F=84．201，P〈0．01），PS、PS＋RM组氧合改善稳定，RM组Pa02随观测时间延长呈下降趋势；（2）4组的PaCO，分别为（56±11）、（46±10）、（51±8）和（46±10）mmHg，对照组明显高于Ps、Ps＋RM组（F=4．234，P〈0．05）。RM组PaCO2随时间延长呈增高趋势；（3）4组动物气道峰压分别为（33±2）、（23±1）、（24±2）和（22±1）cmH：0（1cmH2O=0．098kPa），静态肺顺应性（Cst）分别为（1．1±0．3）、（1．7±0．3）、（1．5±0．1）、（1．9±0．4）ml／cmH20，PS、RM、PS＋RM3组气道峰压、Cst均较对照组显著改善（F值分别为74．911、15．863，均P〈0．01）。RM组Cst改善较Ps＋RM组差（q=2．58，P〈0．05）；（4）PS、RM、PS＋RM3组动物肺损伤评分分别为3．9±0．8、6．1±0．7和4．2±0．6，均低于对照组的13．5±0．7（F=369．6，P〈0．01），RM组高于PS及PS＋RM组（q值分别为6．35、5．70，均P〈0．01）。结论ARDS早期补充外源性PS或实施RM均能有效改善氧合及肺脏顺应性，但RM后易出现肺泡再萎陷及呼吸机相关性肺损伤；PS联合RM治疗能防止肺泡再萎陷，并可减轻呼吸机相关性肺损伤。
Objective To investigate the effects of exogenous pulmonary surfactant （PS）, recruitment maneuver （RM） and the combination of RM with PS in rabbits with acute respiratory distress syndrome （ARDS）. Methods ARDS models were induced in 28 New Zealand white rabbits by repeated airway lavage with normal warm saline, and the animals were ventilated with volume controlled ventilation [VCV, VT8 ml/kg, RR 40/min, PEEP 3 cm H2O （1 cm H2O =0.098 kPa）]. All the rabbits were randomly divided by random digit table into 4 groups （n =7 each） ： a control group, a PS group, a RM group and a PS ＋ RM group. Arterial blood gas analysis, peak inflating pressure （PIP） and static compliance of the respiratory system （Cst） were measured. All the animals were sacrified at 4h of experimental interventional therapy for the examination of pulmonary pathology. Results （ 1 ） The mean PaO2 in the PS group,the RM group and the PS ＋ RM group [ （234 ± 42）mm Hg,（231 ±17） mm Hg, （ 253± 52 ） mm Hg（ 1 mm Hg = 0. 133 kPa）, respectively] was significantly higher than that in the control group [ （74 ± 15 ） mm Hg, F = 84. 201 ,P 〈 0. 01 ]. The improvement in the PS group and the PS ＋ RM group was stable, but in the RM group, the PaO2 gradually decreased. （2） The PaCO2 in the control group [ （56± 11 ） mm Hg] was significantly higher than that in the PS group and the PS ＋ RM group [ （46 ± 10） mm Hg, （46 ± 10） mm Hg, respectively, F=4.234, P 〈0.05]. The PaCO2 in the RM group gradually increased. （3） The respective PIP in the 4 groups was （33±2）, （23± 1 ）, （24 ±2）, （22 ± 1 ） cm H2O; Cst was （ 1.1 ±0. 3）, （ 1.7 ±0. 3）, （ 1.5 ±0. 1 ）, （ 1.9 ±0. 4） ml/cm H2O. Compared with the baseline and with the control group, PIP and Cst in the 3 intervention groups improved significantly （F = 74. 911, 15. 863, P 〈0.01） . The improvement of Cst in the PS ＋ RM group was better than that in the RM group（q =2. 58, P〈0.05）. （4）The lung injury score in the PS group, the RM group and the PS ＋RM group （3.9 ±0.8, 6. 1±0. 7, 4. 2 ±0. 6, respectively） were significantly lower than that in the control group（ 13.5 ±0. 7, F = 369. 6, P 〈 0. 01 ）. The lung injury in the RM group was more severe than that in the PS and PS ＋ RM group （q = 6. 35, 5. 70, all P 〈 0. 01 ）. Conclusions Exogenous PS replacement therapy can improve oxygenation and the compliance of the respiratory system in ARDS rabbits . RM can also improve oxygenation and lung mechanics temporarily, but it may induce ventilator associated lung injury（VALI）. PS replacement combined with RM therapy can alleviate VALI and is more effective in improving oxygenation and lung mechanics.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2009年第7期497-502,共6页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
基金项目：北京市科技新星计划资助项目（2005803）
