呼气末正压通气联合控制性肺膨胀治疗海水淹溺急性肺损伤

目的 探讨呼气末正压通气(PEEP)联合控制性肺膨胀(SI)对海水淹溺致急性肺损伤(SWD-ALI)兔的治疗作用及安全性.方法 应用小潮气量机械通气联合PEEP对42只SWD-ALI兔进行分组救治,通气过程中实施SI,在不同时间点观察血气分析、呼吸力学、血液动力学、肺损伤指标,并进行肺组织学检查,以评价治疗效果及安全性.结果 PEEP联合SI治疗后SWD-ALI兔血氧分压(PaO2)等指标较对照组和PEEP治疗组明显改善(P<0.05),肺顺应性也明显好转(P<0.05),呼吸力学、血液动力学无显著恶化,影像学检查显示肺内渗出明显吸收.结论 在SWD-ALI兔治疗过程中应用PEEP,同时实施SI,能够明显改善氧合,提高肺顺应性,是一种安全有效的治疗SWD-ALI的机械通气手段.

Treatment of acute lung injury induced by seawater drowning with positive end - expiratory pressure ventilation coupled with controlled pulmonary inflation in rabbits

Objective To investigate the effect and safety of positive end-expiratory pressure ventilation (PEEP)coupled with sustained inflation (SI) in the treatment of acute lung injury induced by seawater drowning in rabbits. Methods Forty-two New Zealand rabbits with acute lung injury induced by seawater drowning were treated with lower tidal ventilation coupled with positive end - expiratory pressure ventilation. During sustained inflation, blood gas, pulmodynamics, hemodynamics and lung injury weremonitored at various time points for evaluation of safety and its therapeutic effects. Tumor necrosis factor (TNF-α) and interleukin-6 (IL-6) extracted from serum were also measured following treatment. Pulmonary high-resolution chromatography (HRCT) was made after 3 hours of ventilation. Then, rabbits of both groups were sacrificed for pathological examination. Results Blood gas analysis showed that the partial pressure of arterial oxygen (PaO2) at various time points increased significantly (P < 0. 05), following treatment of the animals with acute lung injury induced by seawater drowning. Lung compliance also increased with statistical significance(P < 0.05). No significant deterioration was noted in both pulmodynamics and hemodynamics.Photographic examination indicated that intrapulmonary exudation absorbed markedly. Conclusions Positive end-expiratory pressure ventilation combined with sustained inflation could significantly improve gas exchange and lung compliance, and it might be a safe and effective method for the treatment of animals with acute lung injury induced by seawater drowning.