CAJ | 학술논문

目的观察不同潮气量(Vt)机械通气对室颤犬复苏后肺泡表面活性物质的影响,探讨心肺复苏的机械通气策略.方法选用健康成年犬24只,体质量(15±2) kg,雌雄不拘,随机(随机数字法)分为3组:对照组(A组)、低Vt组(B组)和高Vt组(C组).对照组仅进行麻醉和气管插管；其余2组经右心室导管诱发室颤制作心搏骤停模型,复苏时分别以不同潮气量(低Vt组:6 ml/kg;高Vt组:20 ml/kg)机械通气6h,观察开始复苏前及机械通气后不同时间点犬动脉血气的变化；比较各组犬复苏成功率及72 h存活情况；采用高效液相色谱法(HPLC)检测肺泡灌洗液中磷脂酰胆碱含量；测定肺组织湿干质量比(W/D)及肺组织病理学改变评分.结果 (1)复苏开始时B、C两组犬pH显著降低,PaO2下降,PaCO2上升,与基础值比较差异具有统计学意义(P＜0.05),复苏后pH、PaO2均升高；C组ROSC 2 h后,PaCO2较B组下降差异具有统计学意义(P＜0.05),ROSC 6 h后,B组与C组比较HCO3-差异具有统计学意义(P＜0.05)；(2)与B组比较,C组磷脂酰胆碱含量减少(P＜0.05),肺组织W/D比值增加(P＜0.05),病理损伤形态学积分升高(P＜0.01).结论低潮气量机械通气减少肺泡表面活性物质的丢失,减轻复苏后肺损伤,可作为复苏及复苏后一种保护性通气策略.
목적 관찰불동조기량(Vt)궤계통기대실전견복소후폐포표면활성물질적영향,탐토심폐복소적궤계통기책략.방법 선용건강성년견24지,체질량(15±2) kg,자웅불구,수궤(수궤수자법)분위3조:대조조(A조)、저Vt조(B조)화고Vt조(C조).대조조부진행마취화기관삽관；기여2조경우심실도관유발실전제작심박취정모형,복소시분별이불동조기량(저Vt조:6 ml/kg;고Vt조:20 ml/kg)궤계통기6h,관찰개시복소전급궤계통기후불동시간점견동맥혈기적변화；비교각조견복소성공솔급72 h존활정황；채용고효액상색보법(HPLC)검측폐포관세액중린지선담감함량；측정폐조직습간질량비(W/D)급폐조직병이학개변평분.결과 (1)복소개시시B、C량조견pH현저강저,PaO2하강,PaCO2상승,여기출치비교차이구유통계학의의(P＜0.05),복소후pH、PaO2균승고；C조ROSC 2 h후,PaCO2교B조하강차이구유통계학의의(P＜0.05),ROSC 6 h후,B조여C조비교HCO3-차이구유통계학의의(P＜0.05)；(2)여B조비교,C조린지선담감함량감소(P＜0.05),폐조직W/D비치증가(P＜0.05),병리손상형태학적분승고(P＜0.01).결론 저조기량궤계통기감소폐포표면활성물질적주실,감경복소후폐손상,가작위복소급복소후일충보호성통기책략.
Objective To observe the effects of mechanical ventilation with different tidal volumes (Vt) on the pulmonary surfactant in dogs during cardiopulmonary resuscitation (CPR) and discuss the strategy of mechanical ventilation for CPR.Methods A total of 24 healthy,adult and mongrel canines were randomly (random number) divided into three groups,namely control group (A),low Vt group (B) and high Vt group (C).Canines without ventricular fibrillation in group A were not supported with mechanical ventilation,while canines in group B and group C were induced to get ventricular fibrillation (VF) with pacing catheter inserted through right external carotid vein into the right ventricle.CPR was initiated with mechanical ventilation with different Vt for 6 hours after ventricular fibrillation.The Vt set in group B was 6 ml/kg body weight and Vt set in group C was 20 ml/kg body weight.The arterial blood gas analyses were tested in different intervals.The levels of phosphatidylchline in bronchia alveolus lavage fluid (BALF) was assayed with high performance liquid chromatography (HPLC).The ratio of wet and dry weight and the morphological change scores of lung tissue were calculated.Results After ventricular fibrillation,pH,PaO2 in both groups B and C decreased and PaCO2 increased in comparison with those before VF (P ＜ 0.05),while pH,PaO2 and PaCO2 were improved after mechanical ventilation.These was statistical difference in PaCO2 between group B and group C 2 h after mechanical ventilation (P ＜ 0.05).There was difference in HCO3-between group B and group C 6 h after ROSC.The rate of successful restoration of spontaneous circulation (ROSC) and the 72 h survival rate were 75％ and 50％ respectively in group B,and 62.5％ and 40％ respectively in group C.There were no statistically different between two groups (P ＞ 0.05).The levels of phosphatidylchline in BALF of group B and C greatly decreased compared with the group A (All P ＜0.01),while phosphatidylcholine detected in the group C decreased much more than that in the group B (P ＜0.01).The W/D ratio and morphological change scores in the group C were higher than those in the group B (P ＜ 0.01).Conclusion Low tidal volume ventilation can reduce the loss of pulmonary surfactant and mitigate pulmonary injury.Therefore it may be a protective ventilation strategy after resuscitation.