CAJ | 학술논문

目的通过研究部分液体通气(PLV)对胎粪性急性肺损伤病理学变化的影响,探讨PLV对治疗胎粪性急性肺损伤的效果.方法 68只健康新西兰兔随机分6组,用20%健康新生儿胎粪混悬液3 mL/kg造模,再行机械通气.使用PLV组:全氟化碳(PFC)按3 ml/kg注入兔肺内,再机械通气.造模后6 h处死动物,取兔肺进行病理学检查和评分.结果相对于常频组(3.0±0),常频(PLV)组(2.4±0.6)和高频(PLV)组(2.4±0.6)可以明显降低炎性细胞浸润(P＜0.01),且高频组(2.1±0.3)也有类似作用(P＜0.05).只有高频(PLV)组(1.0±0.7)的肺水肿情况好于常频组(2.0±0.8)(P＜0.01).常频组(2.6±0.5)较容易出现小气道损伤,常频(PLV)组(1.1±0.4)和高频(PLV)组(0.9±0.3)的小气道损伤则不明显(P＜0.01).未发现PLV对肺出血有效.相对于常频组和高频组,使用PLY二组的死亡率较低(21.4%/14.3%).结论 PLV可以明显减轻胎粪性急性肺损伤,并对降低死亡率有一定作用,因而PLV具有临床应用的良好前景.英文作者简介:ZHU Jian-xing (Email:jxzhu.my265@yahoo.com.cn)
목적 통과연구부분액체통기(PLV)대태분성급성폐손상병이학변화적영향,탐토PLV대치료태분성급성폐손상적효과.방법 68지건강신서란토수궤분6조,용20%건강신생인태분혼현액3 mL/kg조모,재행궤계통기.사용PLV조:전불화탄(PFC)안3 ml/kg주입토폐내,재궤계통기.조모후6 h처사동물,취토폐진행병이학검사화평분.결과상대우상빈조(3.0±0),상빈(PLV)조(2.4±0.6)화고빈(PLV)조(2.4±0.6)가이명현강저염성세포침윤(P＜0.01),차고빈조(2.1±0.3)야유유사작용(P＜0.05).지유고빈(PLV)조(1.0±0.7)적폐수종정황호우상빈조(2.0±0.8)(P＜0.01).상빈조(2.6±0.5)교용역출현소기도손상,상빈(PLV)조(1.1±0.4)화고빈(PLV)조(0.9±0.3)적소기도손상칙불명현(P＜0.01).미발현PLV대폐출혈유효.상대우상빈조화고빈조,사용PLY이조적사망솔교저(21.4%/14.3%).결론 PLV가이명현감경태분성급성폐손상,병대강저사망솔유일정작용,인이PLV구유림상응용적량호전경.영문작자간개:ZHU Jian-xing (Email:jxzhu.my265@yahoo.com.cn)
Objective To observe the pathological change of partial liquid ventilation (PLV) throush establishing the rabbit model of acute lung injury (ALI) induced by meconium aspiration.Methods Adult,healthy male or female Now Zealand white rabbits were randomly allocated into six groups as follows:(1) control group,(2) conventional mechanical ventilation (CMV) group,(3) high-frequency oscillatory ventilation (HFOV) group,(4) CMV combined with PLV group,(5)HFOV combined with PLV group and (6) normal group.The animals were anesthetized with 1% pentobacbital and tracheotomy was performed and endotracheal tube was placed,20% meconium fluid (3 ml/kg) was quickly injected into the lung through the endotracheal tube and arterial blood gas was analyzed 30 minutes later.ALI was indicated when P/F ratio (PaO2/FiO2) was ≤300 mm Hg (1 mm Hg=0.133 kPa) and Cdyn Dynamic Compliance declined by more than 30% of the baseline.The animals were then randomly allocated into one of the 6 groups.In PLV groups (including CMV+PLV and HFOV+PLV) warmed (37℃) and oxygenated peffluorocarbon was slowly instilled into the lungs of the rabbits through the endotracheal tube at a low.dose 3 ml/ks,then set 15-min positive pressure by sacculus propriius to guarantee perfluorocarbon to steadily diffuse in to the lungs.Six hours after ventilation the animals were sacrificed by using overdose of room air instillation via vein.The lungs were taken and fixed in 4% paraformaldehyde (PFA) and were stained with hematoxylin-eosin (HE).Pathological evaluations inchded inflammatory manifestation,edema and hemorrhage in both alveolar and interstitial area,damages of small airway (alveolar tube and alveolar bursa) and hyaline membrane formation.One way analysis of variance,Smdent Newman-Keuls (SNK) method and Kruskal-Wallis (K-W) test were used for comparisong.Results With the exception of normal group 30 minutes after meconinm injections blood gas analysis in different groups showed significant changes and PaO2/FiO2(＜300 mm Hg),Cdyn declined by more than 60% compared with baseline (P＜0.05).The pathological analysis showed that alveolar and interstitial inflammation,edema,alveolar and interstitial hemorrhage,and small airway damage existed in each group.The hyaline membrane formation was found in one of CMV+PLV group rabbits.The perfluorocarbon-treated animals (CMV+PLV and HFOV+PLV) showed significantly less injury in dependent lung and less dislike of small airway (CMV+PLV or HFOV+PLV vs CMV=1.1±0.4 or 0.9±0.3 vs 2.6±0.5) compared with the animals of CMV group (P＜0.01).HFOV group (2.1±0.3) also had less alveolar and interstitial inflammation compared with CMV group (3.0±0)(P＜0.05),and there was less evidence of alveolar and interstitial edema in the animals treated with HFOV 4-PLV(1.0±0.7) compared with CMV (2.0±0.8)(P＜0.01).Treatment with perfluorocarben did not result in significant difference in alveolar and interstitial hemorrhage.Compared with CMV and HFOV groups,the groups treated with PLV showed lower mortality of animals (21.4% and 14.3%).Conclusions PLV can alleviate the histological damage of acute lung injmy induced by meconium aspiration and increased survival chance and therefore PLV would be a useful treatment for MAS.The effectiveness and safety of application of PLV should be evaluated in clinical studies.