中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2008年
12期
1259-1262
,共4页
肺灌洗%肺表面活性物质%外源性肺表面活性物质治疗%烧伤,吸入性
肺灌洗%肺錶麵活性物質%外源性肺錶麵活性物質治療%燒傷,吸入性
폐관세%폐표면활성물질%외원성폐표면활성물질치료%소상,흡입성
Lung lavage%Pulmonary suffactant%Exogenous surfactant therapy%Bums,inhalation injury
目的 探讨外源性肺表面活性物质(PS)稀释剂延迟肺灌洗对大鼠严重烟雾吸入伤后内源性PS功能障碍和急性呼吸衰竭的治疗效果.方法 90只Wistar大鼠随机分为5组:Ⅰ组,正常对照(n=14);Ⅱ组,烟雾吸入(n=27);Ⅲ组,烟雾+PS灌洗+机械通气(MV),n=21;Ⅳ组,烟雾+盐水灌洗+MV,n=10;V组,烟雾+MV,n=18.伤后2 h经气管插管注入含PS(100ms/ks)的等渗盐水30 ml/kg或等量盐水行肺灌洗,MV 4 h,观察24 h;检测动脉血气、肺水量、静态肺顺应性(Cst)、支气管肺泡灌洗液(BAIF)蛋白含量、BALF表面张力特性和24 h病死率等.结果 致伤动物伤后立即出现严重缺氧和一氧化碳中毒;Ⅱ组发生急性呼吸衰竭、高通透性肺水肿和PS功能障碍;Ⅲ组Cst和BALF表面张力特性显著改善(P<0.05),但氧合能力、肺水量和BALF蛋白含量无明显好转(P>0.05).Ⅳ、V组疗效不佳.结论 外源性PS稀释剂延迟肺灌洗可一定程度恢复烟雾吸入所致内源性PS功能抑制,改善肺功能,但不能显著减轻高通透性肺水肿和呼吸衰竭,不能降低早期病死率.
目的 探討外源性肺錶麵活性物質(PS)稀釋劑延遲肺灌洗對大鼠嚴重煙霧吸入傷後內源性PS功能障礙和急性呼吸衰竭的治療效果.方法 90隻Wistar大鼠隨機分為5組:Ⅰ組,正常對照(n=14);Ⅱ組,煙霧吸入(n=27);Ⅲ組,煙霧+PS灌洗+機械通氣(MV),n=21;Ⅳ組,煙霧+鹽水灌洗+MV,n=10;V組,煙霧+MV,n=18.傷後2 h經氣管插管註入含PS(100ms/ks)的等滲鹽水30 ml/kg或等量鹽水行肺灌洗,MV 4 h,觀察24 h;檢測動脈血氣、肺水量、靜態肺順應性(Cst)、支氣管肺泡灌洗液(BAIF)蛋白含量、BALF錶麵張力特性和24 h病死率等.結果 緻傷動物傷後立即齣現嚴重缺氧和一氧化碳中毒;Ⅱ組髮生急性呼吸衰竭、高通透性肺水腫和PS功能障礙;Ⅲ組Cst和BALF錶麵張力特性顯著改善(P<0.05),但氧閤能力、肺水量和BALF蛋白含量無明顯好轉(P>0.05).Ⅳ、V組療效不佳.結論 外源性PS稀釋劑延遲肺灌洗可一定程度恢複煙霧吸入所緻內源性PS功能抑製,改善肺功能,但不能顯著減輕高通透性肺水腫和呼吸衰竭,不能降低早期病死率.
목적 탐토외원성폐표면활성물질(PS)희석제연지폐관세대대서엄중연무흡입상후내원성PS공능장애화급성호흡쇠갈적치료효과.방법 90지Wistar대서수궤분위5조:Ⅰ조,정상대조(n=14);Ⅱ조,연무흡입(n=27);Ⅲ조,연무+PS관세+궤계통기(MV),n=21;Ⅳ조,연무+염수관세+MV,n=10;V조,연무+MV,n=18.상후2 h경기관삽관주입함PS(100ms/ks)적등삼염수30 ml/kg혹등량염수행폐관세,MV 4 h,관찰24 h;검측동맥혈기、폐수량、정태폐순응성(Cst)、지기관폐포관세액(BAIF)단백함량、BALF표면장력특성화24 h병사솔등.결과 치상동물상후립즉출현엄중결양화일양화탄중독;Ⅱ조발생급성호흡쇠갈、고통투성폐수종화PS공능장애;Ⅲ조Cst화BALF표면장력특성현저개선(P<0.05),단양합능력、폐수량화BALF단백함량무명현호전(P>0.05).Ⅳ、V조료효불가.결론 외원성PS희석제연지폐관세가일정정도회복연무흡입소치내원성PS공능억제,개선폐공능,단불능현저감경고통투성폐수종화호흡쇠갈,불능강저조기병사솔.
Objective To investigate the therapeutic effects of delayed lung lavage with exogenous pulmonary surfactant(PS)diluent on endogenous surfactant system dysfunction and acute respiratory failure caused by severe smoke inhalation in rats.Method Ninety Wistar rats were randomly separated into five groups:Group I,normal control(n=14);Group Ⅲ,smoke inhalation(n=27);GroupⅢ,smoke+PS lavage+mechanical ventilation(MV),n=21;Group IV,smoke+saline lavage+MV,n=10;Group V,smoke+MV,n=18.The lungs were lavaged with 30 ml/kg normal ssdine containing 100 mg/kg PS or same volume of saline via tra cheal catheter at 2 h after smoke inhalation,then the animals were placed on a ventilator for 4 h,and observed until 24 h after injury.The arterial blood gas level,lung water volume,static lung compliance(Cst),total protein and albumin contents in bronchoalveolar lavage fluid(BALF),surface tension properties of BALF,and fatality rate at 24 h were measured.Results Smoke inhalation caused a similar acute hypoxia and severe carbon monoxide poisoning immediately in all injured groups.The animals in group Ⅱ showed acute respiratory failure,serious hish permeability pulrnonary edema,and surfactant system dysfunction.The surface tension properties of BALF and Cst were significantly improved by delayed lung lavage treated with exogenous PS diluent in group m(P<0.05).However,the lung water volume,total protein and albumin contents in BALF and the oxygenation had not significant difference between group Ⅲ and group Ⅱ(P>0.05).Conclusions Delayed lung lavage with exogenous PS diluent,at a certain extemt,restored endogenous suffactant function inhibited by smoke inhalation and improved lung function.Nevertheless,the trent could not alleviate rash permeability pulmonary edema and respiratory failure drarnatically.The expected decrease of mortality at early stage after smoke inhalation injury was not showed yet.
