中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2008年
10期
592-596,插1
,共6页
许启霞%詹庆元%王辰%庞宝森%杜敏捷
許啟霞%詹慶元%王辰%龐寶森%杜敏捷
허계하%첨경원%왕신%방보삼%두민첩
急性呼吸窘迫综合征%俯卧位通气%肺复张%肺保护性通气策略%细胞因子%肺湿/干重比值%病理评分
急性呼吸窘迫綜閤徵%俯臥位通氣%肺複張%肺保護性通氣策略%細胞因子%肺濕/榦重比值%病理評分
급성호흡군박종합정%부와위통기%폐복장%폐보호성통기책략%세포인자%폐습/간중비치%병리평분
acute respiratory distress syndrome%prone position ventilation%recruitment maneuver%lung protective ventilation strategy%inflammatory factor%lung wet/dry weight ratio%pathological score
目的 评价俯卧位通气(PPV)联合肺复张(RM)对急性呼吸窘迫综合征(ARDS)犬的肺保护作用及机制.方法 经股静脉快速注入油酸建立犬ARDS模型,容积控制通气,在小潮气量(VT,10 ml/kg)+高呼气末正压(PEEP,16 cm H2O,1 cm H2O=0.098 kPa)通气基础上,按随机数字表法分为仰卧位组、俯卧位组、仰卧+RM组、俯卧+RM组,每组6只.测定通气后0.5、2和4 h血清细胞因子.4 h后经股动脉放血处死动物,开胸取肺;取左肺组织制备匀浆,测定细胞因子;取右肺测定湿/干重(W/D)比值及制备病理切片,行病理评分.结果 ①通气4 h时仰卧+RM组血清白细胞介素-8(IL-8)浓度明显高于其他3组(P均<0.05),且仰卧+RM组血清肿瘤坏死因子-α(TNF-α)浓度明显高于俯卧位组及俯卧+RM组(P均<0.05).②俯卧位组及俯卧+RM组背侧肺组织匀浆中IL-8浓度明显低于仰卧位组(P均<0.05),TNF-α浓度明显低于仰卧+RM组(P均<0.05).③俯卧位组、俯卧+RM组右肺W/D比值明显低于仰卧位组及仰卧+RM组(P均<0.05).④俯卧位组及俯卧+RM组背侧病理评分显著低于仰卧位组及仰卧+RM组(P均<0.05).结论 在犬ARDS模型中,予以小VT+PEEP的肺保护性通气时,在俯卧位实施RM可以减轻肺损伤.
目的 評價俯臥位通氣(PPV)聯閤肺複張(RM)對急性呼吸窘迫綜閤徵(ARDS)犬的肺保護作用及機製.方法 經股靜脈快速註入油痠建立犬ARDS模型,容積控製通氣,在小潮氣量(VT,10 ml/kg)+高呼氣末正壓(PEEP,16 cm H2O,1 cm H2O=0.098 kPa)通氣基礎上,按隨機數字錶法分為仰臥位組、俯臥位組、仰臥+RM組、俯臥+RM組,每組6隻.測定通氣後0.5、2和4 h血清細胞因子.4 h後經股動脈放血處死動物,開胸取肺;取左肺組織製備勻漿,測定細胞因子;取右肺測定濕/榦重(W/D)比值及製備病理切片,行病理評分.結果 ①通氣4 h時仰臥+RM組血清白細胞介素-8(IL-8)濃度明顯高于其他3組(P均<0.05),且仰臥+RM組血清腫瘤壞死因子-α(TNF-α)濃度明顯高于俯臥位組及俯臥+RM組(P均<0.05).②俯臥位組及俯臥+RM組揹側肺組織勻漿中IL-8濃度明顯低于仰臥位組(P均<0.05),TNF-α濃度明顯低于仰臥+RM組(P均<0.05).③俯臥位組、俯臥+RM組右肺W/D比值明顯低于仰臥位組及仰臥+RM組(P均<0.05).④俯臥位組及俯臥+RM組揹側病理評分顯著低于仰臥位組及仰臥+RM組(P均<0.05).結論 在犬ARDS模型中,予以小VT+PEEP的肺保護性通氣時,在俯臥位實施RM可以減輕肺損傷.
목적 평개부와위통기(PPV)연합폐복장(RM)대급성호흡군박종합정(ARDS)견적폐보호작용급궤제.방법 경고정맥쾌속주입유산건립견ARDS모형,용적공제통기,재소조기량(VT,10 ml/kg)+고호기말정압(PEEP,16 cm H2O,1 cm H2O=0.098 kPa)통기기출상,안수궤수자표법분위앙와위조、부와위조、앙와+RM조、부와+RM조,매조6지.측정통기후0.5、2화4 h혈청세포인자.4 h후경고동맥방혈처사동물,개흉취폐;취좌폐조직제비균장,측정세포인자;취우폐측정습/간중(W/D)비치급제비병리절편,행병리평분.결과 ①통기4 h시앙와+RM조혈청백세포개소-8(IL-8)농도명현고우기타3조(P균<0.05),차앙와+RM조혈청종류배사인자-α(TNF-α)농도명현고우부와위조급부와+RM조(P균<0.05).②부와위조급부와+RM조배측폐조직균장중IL-8농도명현저우앙와위조(P균<0.05),TNF-α농도명현저우앙와+RM조(P균<0.05).③부와위조、부와+RM조우폐W/D비치명현저우앙와위조급앙와+RM조(P균<0.05).④부와위조급부와+RM조배측병리평분현저저우앙와위조급앙와+RM조(P균<0.05).결론 재견ARDS모형중,여이소VT+PEEP적폐보호성통기시,재부와위실시RM가이감경폐손상.
Objective To evaluate protective effect and its mechanism of prone position ventilation (PPV) combined with recruitment maneuver (RM) as a lung protective ventilation strategy on oleic acid-induced acute respiratory distress syndrome (ARDS) in dogs. Methods Twenty-four oleic acid-induced ARDS dogs were ventilated with volume controlled ventilation (VCV): 16 cm H2O (1 cm H2O=0.098 kPa) of positive end-expiratory pressure (PEEP) and 10 ml/kg of tidal volume (VT). All dogs were randomly divided by random digit table into four groups: supine position (SP group), prone position (PP group), supine position+RM (SPRM group), and prone position+RM (PPRM group, 6 in each group), and ventilated by VCV for 4 hours and then sacrificed by exsanguination. The serum levels of inflammatory mediators were measured respectively at 0.5, 2 and 4 hours. After they were sacrificed, the levels of cytokines in left lung tissue homogenate were measured. The wet/dry weight ratio of right lung was determined and histological sections of the lungs were prepured and examined. Results ①At 4 hours, interleukin-8 (IL-8) in serum in the SPRM group was significantly higher than in other three groups (all P＜0.05), tumor necrosis factor-α (TNF-α) in serum in the SPRM group was significantly higher than in the PP group and the PPRM group (all P＜0.05). ②IL-8 in lung tissue homogenate of the dorsal aspect of the lung in the SP group was higher than in the PP group and the PPRM group (both P＜0.05). TNF-α in lung tissue homogenate at the dorsal aspect of the lung in the SPRM group was higher than in the PP group and the PPRM group (both P＜0.05). ③Wet/dry weight ratio of right lung in the PP group and the PPRM group were significantly lower than that in the SP group and the SPRM group (all P＜0.05). ④Pathology score of lung tissue at the dorsal aspect of the lung in the PP group and PPRM group was significantly lower than in the SP group and the SPRM group (all P＜0.05). Conclusion Protective ventilation strategy combined with RM is safer in prone position than supine position, and it alleviates lung injury in dog with ARDS.
