高频部分液体通气对吸入伤犬呼吸循环功能的影响

目的　观察高频部分液体通气 (highfrequencypartialliquidventilation ,HFPLV)对吸入性损伤犬肺力学、氧合和血流动力学参数的影响。　方法　 16条犬经吸入蒸气 ,造成重度吸入性损伤模型 ,并随机分为对照组和治疗组。两组动物致伤后均行高频喷射通气 (highfrequencyjetventila tiot,HFJV) ,治疗组同时经气管导管缓慢注入氟碳液体 (3ml/kg体重 ) ,行HFPLV治疗 ,于通气后3 0、60和 90min时测定两组动物血气、肺顺应性、气道阻力及血流动力学参数。　结果　治疗组PaO2 呈进行性上升 ,在各时相点与致伤后比较差异有显著性意义 (P <0 .0 5 ) ,而对照组各时相点与致伤后比较差异无显著性意义 (P >0 .0 5 ) ;治疗组PaCO2 也逐渐增高 ,于 60、90min显著高于致伤后水平 (P <0 .0 5 )。与对照组比较 ,治疗组各时相点的PaO2 稍有升高 (P >0 .0 5 ) ,PaCO2 于 90min显著增高 (P <0 .0 5 ) ,而两组动 /静态气道阻力、肺顺应性和血流动力学参数比较 ,差异均无显著性意义 (P >0 .0 5 )。　结论　HFPLV与单纯HFJV相比 ,更有利于吸入性损伤的动脉氧合 ,对血流动力学参数无明显不利影响     

吸入性损伤犬部分液体通气后一氧化氮含量的改变

部分液体通气 (ＰＬＶ)用于治疗急性肺损伤、成人或新生儿呼吸窘迫综合征 ,能改善氧分压和肺顺应性 ,国外已用于Ⅱ、Ⅲ期临床试验[1] 。本研究以吸入性损伤犬为模型 ,观察部分液体通气后其体内一氧化氮 (ＮＯ)含量的改变。材　料　与　方　法健康杂种犬 12条 ,体重 (10 .0 0± 1.0 5 )ｋｇ ,雌雄不拘 ,随机分为治疗组和对照组 ,每组 6条。质量浓度 30 ｇ/Ｌ戊巴比妥静脉麻醉 (1ｍｌ/ｋｇ) ,取仰卧位 ,气管插管 ,接呼吸机 (美国Ｂｉｒｄ 84 0 0型 )。按文献 [2 ]制作蒸气吸入性损伤犬模型。伤后 1ｈ ,给氧浓度调整为 0 .6 0并保持恒定。伤后 …     

部分液体通气对吸入性损伤犬的研究

目的 观察部分液体通气(PLV)对吸人性损伤犬呼吸力学、氧合和血流动力学参数的影响.方法 16条健康杂种犬经蒸气吸人造成重度吸入性损伤模型,随机分为对照组和实验组(n=8).实验组经气管导管缓慢注入氟碳液体(12ml/kg体重)行PLV治疗,治疗后30、60、90 min时测定两组犬血气、气道阻力、肺顺应性及血流动力学参数.结果 实验组Pa02呈进行性上升,在各时点与致伤后60 min比较差异有统计学意义(P＜0.05).与对照组比较,实验组各时点的PaO2稍有升高(P＞0.05).两组气道阻力、肺顺应性和血流动力学参数比较,差异均无统计学意义(P＞0.05).结论 PLV有利于吸入性损伤犬的动脉氧合,对血流动力学无明显不利影响.     

吸入性损伤犬降钙素的变化

目的单因素观察吸入性损伤或烧伤后血清免疫反应性降钙素(iCT)的变化,分析其诊断意义。方法将24只犬随机分为单纯吸入性损伤后中度(A)、重度(B)、特重度损伤(C)组及单纯重度烧伤(D)组,每组6只。吸人性损伤犬均在伤后6 h行纤维支气管镜检查,以明确其损伤程度。分别于不同时相点抽取犬静脉血检测iCT含量,抽取动脉血做血气分析。结果(1)经纤维支气管镜检查,证实A、B、C组犬符合吸入性损伤的预期程度。(2)与伤前值(38±22)ng／L比较,各组吸人性损伤犬iCT含量在伤后1 h均明显升高(P<0．05),伤后4 h明显高于D组(P(0．05),其中A组于24 h达峰值(453±224)ng／L,B、C组在48 h内呈进行性升高。D组犬iCT含量在伤后2 h开始持续升高,至伤后48 h为(125±41)ng／L。(3)血气分析结果显示,与伤前值(109±8)mm Hg (1 mm Hg=0．133 kPa)比较,A、D两组氧分压(PaO2)伤后各时相点无明显差异(P>0．05),B、C组犬从伤后8 h和伤后4 h开始持续下降,分别为(65±6)、(71±9)mm Hg。与二氧化碳分压(PaCO2)的伤前值(38±5)mm Hg比较,C组犬伤后24 h PaCO2开始升高[(52±11)mm Hg]。结论在吸入性损伤后8 h内,iCT的变化明显早于血气分析指标,其诊断意义接近纤维支气管镜检查。     

ALI/ARDS病人侧卧位通气的疗效观察

目的探讨急性肺损伤 /急性呼吸窘迫综合征 (ALI/ARDS)病人实施侧卧位通气的效果。方法对 18例ALI/ARDS病人实施侧卧位通气 ,分别于通气前、侧卧位通气 1h后及恢复仰卧位通气 1h做血气分析 ,观察变动体位通气对呼吸循环指标的影响。结果 12例侧卧位通气有效 ,有效率 6 6 .7% ;其氧分压 (PaO2 )、氧分压 /吸氧浓度 (PaO2 /FiO2 )明显高于通气前 (均P <0 .0 1) ;恢复仰卧位 1h后上述指标有所下降 ,但仍高于通气前 (P <0 .0 5 ) ;体位变动通气时病人呼吸循环指标变化比较 ,差异无显著性意义 (均P >0 .0 5 )。结论侧卧位通气对ALI/ARDS特别是对ALI病人治疗有效 ,与俯卧位通气比较 ,实施更方便、安全。     

高频喷射通气对重度烧伤合并吸入性损伤患者早期的呼吸支持

目的　观察高频喷射通气 (highfrequencyjetventilation ,HFJV)对重度烧伤合并吸入性损伤患者早期的治疗作用。　方法　 2 0例重度烧伤 (TBSA 79.6 %± 2 9.3% )并吸入性损伤患者 ,其中 19例行气管切开手术 ,1例经鼻插管。为防低氧血症 ,所有患者均应用HFJV ,观察通气前和通气后 11d内血气、呼吸率和脉搏等指标的变化。　结果　气管切开时间为伤后 (2 .7± 2 .4 )d ,HFJV时间为伤后(4.4 0± 2 .9)d。HFJV后 1～ 3d ,PaO2 显著高于通气前水平 (P <0 .0 1) ,随后HFJV 1周 ,PaO2 仍维持在较高水平。在整个通气期间 ,PaCO2 、呼吸率和脉搏率均无明显变化。结论　在重度烧伤合并吸入性损伤早期 ,HFJV有利于氧合作用的改善而无明显副作用 ,是一较为适用的呼吸支持方式     

部分液体通气与吸入NO对急性肺损伤动物疗效的对比研究

目的对肺灌洗(Lavage)诱导的急性肺损伤(ALI)家猪实施以氟碳(PFC)为媒介的部分液体通气(PLV)及吸入20ppm的一氧化氮(NO),比较二者对肺气体交换及血液动力学的影响.方法24头健康家猪,麻醉后经气管导管肺内以生理盐水反复灌洗,直至动脉氧分压(PaO2)<100mmHg达1h,记录气体交换及血液动力学各参数作为急性肺损伤的基础值.随机分为PLV组、NO组及对照组,PLV组肺内灌以相当于肺功能余气量(30ml/kg)的PFC,然后以普通呼吸机行常规气体通气,补充PFC4ml·kg-1·h-1以弥补蒸发损失;NO组吸入20ppmNO,对照组不给予其它治疗,各组每小时记录气体交换及血液动力学各参数的变化.结果PLV组实施PLV1h后,PaO2即从ALI时的(53±11)mmHg升高至(142±133)mmHg,4h后达(318±109)mmHg,与ALI时比较差异有显著性(P＜0.01),亦显著高于对照组(P＜0.05).实施PLV1h后Qs/Qt从ALI时的(57±9)%降至(42±13)%,4h后降至(26±10)%,较ALI时差异有显著性(P＜0.01),并于2h后显著低于对照组(P＜0.05).NO组的MPAP在整个实验过程中显著低于对照组(P＜0.01).NO组吸入NO1h后,PaO2即呈上升趋势,4h后从ALI时的65±14升至(114±36)mmHg,与对照组比较差异有显著性(P＜0.05).同时肺内分流(Qs/Qt)及肺泡-动脉氧压差(AaDO2)降低.MAP及体循环血管阻力(SVR)与对照组比较无显著性改变.结论以氟碳为媒介的部分液体通气及吸入20ppm的NO均能有效的改善ALI动物肺气体交换.吸入NO能显著降低MPAP,而PLV更能显著的升高PaO2.     

腺苷对犬心肺联合移植供肺缺血-再灌注损伤的保护作用

目的 研究腺苷(ADO)对犬心肺联合移植供肺缺血-再灌注(I/R)损伤的保护作用.方法 建立犬心肺联合移植模型,将实验分为心肺联合移植对照组(对照组)和腺苷组,观察恢复血流灌注后30、60、90和120 min时两组犬动脉血氧分压(PaO2)的变化;测定缺血前10 min、缺血后10 min、120 min、再灌注后10 min、60 min供肺组织一氧化氮(NO)含量;在恢复血流灌注60 min后,取供肺组织为标本,检测肺组织中髓过氧化物酶(MPO)活力、丙二醛(MDA)含量、超氧化物歧化酶(SOD)含量以及肺组织湿干重比(W/D);HE染色光学显微镜下观察病理变化.结果 (1)在各时间点腺苷组PaO2值较对照组明显升高(P＜0.05);(2)与缺血前比较,缺血后120min、再灌注后10min和60min的肺组织NO含量均显著降低(P＜0.05),而腺苷组缺血后120 min、再灌注后10 min和60 min肺组织NO含量显著高于对照组(P＜0.05);(3)腺苷组肺组织中MPO活力、MDA含量、肺组织W/D显著低于对照组,SOD含量显著高于对照组(P＜0.05);(4)病理切片观察显示对照组的肺组织呈严重的炎性细胞浸润及肺水肿形成,而腺苷组的病变程度较对照组轻微.结论 在心肺联合移植过程中应用ADO,对供肺的缺血-再灌注损伤有保护作用.     

犬气管插管全麻下吸入不同浓度氧时自由基及肺超微结构的变化

目的　观察犬气管插管全麻下吸入不同浓度氧时的自由基及肺超微结构变化。方法　健康杂种犬 2 0只 ,随机分为纯氧组 (1组 ,FIO2 =1,n =10 )及 4 0 %氧气组 (2组 ,FIO2 =0 4 ,n =10 )。两组麻醉方法相同 ,均行气管内插管 ,接呼吸机机械控制呼吸。监测SOD、MDA在气管插管后1、3、5、7h的变化 ,并在电镜下观察肺组织的超微结构变化。结果　 (1)与基础值比较 ,1组插管后 1、3、5、7hSOD活力明显下降、MDA值明显升高 (P <0 0 1) ;(2 )组间比较 ,1组SOD活力较 2组明显下降 (P <0 0 1)、MDA值明显上升 (P <0 0 1或P <0 0 5 ) ;(3)肺超微结构变化 ,1组观察到的肺损伤重于 2组。结论　纯氧通气氧自由基产生明显增多 ,纯氧通气 7h后观察到的肺超微结构损伤较多 ,推测氧自由基在高氧肺损伤中发挥重要作用     

蒸汽吸入性损伤犬支气管肺泡灌洗液的观察

为了探讨吸入性损伤后支气管肺泡灌洗液检测的意义,选用12条本地健康杂种犬进行自身对照试验。采用蒸汽致伤造成重度吸入性损伤,在伤后1小时和5小时观察支气管肺泡灌洗液(BALF)中细胞成份、总蛋白含量、丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性和血管紧张素转换酶(ACE)活性的变化。结果表明,吸入性损伤后肺内大量炎性细胞渗出,脂质过氧化反应水平增高和肺毛细血管内皮细胞损伤。     

Effect of PEEP and inhaled nitric oxide on pulmonary gas exchange during gaseous and partial liquid ventilation with small volumes of perfluorocarbon

BACKGROUND: Partial liquid ventilation, positive end-expiratory pressure (PEEP) and inhaled nitric oxide (NO) can improve ventilation/perfusion mismatch in acute lung injury (ALI). The aim of the present study was to compare gas exchange and hemodynamics in experimental ALI during gaseous and partial liquid ventilation at two different levels of PEEP, with and without the inhalation of nitric oxide. METHODS: Seven pigs (24+/-2 kg BW) were surfactant-depleted by repeated lung lavage with saline. Gas exchange and hemodynamic parameters were assessed in all animals during gaseous and subsequent partial liquid ventilation at two levels of PEEP (5 and 15 cmH2O) and intermittent inhalation of 10 ppm NO. RESULTS: Arterial oxygenation increased significantly with a simultaneous decrease in cardiac output when PEEP 15 cmH2O was applied during gaseous and partial liquid ventilation. All other hemodynamic parameters revealed no relevant changes. Inhalation of NO and instillation of perfluorocarbon had no additive effects on pulmonary gas exchange when compared to PEEP 15 cmH2O alone. CONCLUSION: In experimental lung injury, improvements in gas exchange are most distinct during mechanical ventilation with PEEP 15 cmH2O without significantly impairing hemodynamics. Partial liquid ventilation and inhaled NO did not cause an additive increase of PaO2.     

High-frequency percussive ventilation as a salvage modality in adult respiratory distress syndrome: a preliminary study

Despite multiple advances in critical care patients with severe adult respiratory distress syndrome (ARDS) can exhaust the capability of conventional ventilation; this results in respiratory failure and death. High-frequency percussive ventilation (HFPV), which was initially utilized for salvage of burn patients with smoke inhalation injury refractory to conventional ventilation, has evolved as a standard of burn care. Based on our experience with HFPV in burn patients the burn team was consulted to provide salvage ventilation for non-burn surgical intensive care unit patients with refractory respiratory failure. Over a 14-month period ten patients with refractory ARDS from multiple causes were treated. Retrospective chart review was performed. Respiratory parameters were assessed before and 24 hours after initiation of HFPV. Mean values of fraction of inspired oxygen (FiO2), pH, partial pressure of O2 in arterial blood (PaO2), partial pressure of CO2 in arterial blood (PaCO2), HCO3, oxygen saturation in arterial blood (SaO2), PaO2/FiO2, and peak inspiratory pressure were compared. Significant improvement in oxygenation was reflected by increases in SaO2, PaO2, and the PaO2/FiO2 ratio in the first 24 hours of HFPV. No significant increase in peak inspiratory pressure was documented by conversion from conventional ventilation to HFPV. No hemodynamic changes directly associated with HFPV were noted. Seven of ten patients failing conventional ventilation survived to hospital discharge after salvage therapy with HFPV. We advocate further studies of HFPV in non-burn patients with ARDS both as salvage therapy and as replacement for conventional ventilation for the initial treatment for ARDS.     

氟碳溶液部分液体通气对烟雾吸入伤大鼠肺静态顺应性的影响

目的:探讨氟碳溶液部分液体通气对烟雾吸入伤大鼠肺静态顺应性的影响。方法:在大鼠烟雾吸入伤模型上建立部分液体通气和机械通气方法,肺总静态顺应性(C_(2.94))和低容量肺顺应性(C_(0.94))用水检压计法测定,同时计算肺扩张指数(EI)。结果:烟雾吸入伤6小时C_(2.49)、C_(0.49)和EI明显低于正常对照组(P<0.01),机械通气治疗对C_(2.94)、C_(0.49)和EI无明显影响(P>0.05);与吸入伤和机械通气组相比,部分液体通气明显增加C_(2.94)、C_(0.49)和EI(P<0.05,P<0.01)。结论:氟碳溶液部分液体通气能明显改善烟雾吸入伤大鼠的肺静态顺应性。     

重度蒸汽吸入性损伤后组织氧合的变化

采用蒸汽吸入造成实验犬急性肺损伤，探讨伤后心输出量（ＣＯ）、氧供量（ＤＯ_２）、氧耗量（ＶＯ_２）、氧摄取率（ＥＲＯ_２）、动脉和混合静脉血氧分压（ＰａＯ_２和ＰｖＯ_２）、动脉和混合静脉血氧饱和度（ＳａＯ_２和ＳｖＯ_２）、肺泡氧分压（Ｐ_ＡＯ_２）以及肺泡－动脉氧分压差（Ｐ_（Ａ－ａ）Ｏ_２）等变化。结果表明，蒸汽吸入４ｈ内，ＣＯ、Ｄ０_２、ＰａＯ_２、ＰｖＯ_２、ＳａＯ_２、ＳｖＯ_２、ＰＡＯ_２和ｐＨ值均显著下降（Ｐ＜０．０１）、Ｐ_（Ａ－ａ）Ｏ_２、ＥＲＯ_２和ＰａＣＯ_２均显著升高（Ｐ＜０．０１和０．０５），ＶＯ_２则无显著变化。提示，蒸汽吸入性损伤后２～４ｈ即可出现组织缺氧，其直接原因是组织灌注和供氧不足。     

深低温期间高氧血气管理对停循环兔脑组织的保护作用

目的通过研究深低温期间高氧血气管理对深低温停循环(DHCA)兔血气、生化指标、脑组织中超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量、脑组织含水量的影响,探讨高氧管理的脑保护作用。方法建立兔DHCA+选择性脑灌注(ASCP)动物模型,将24只11～13周龄雄性新西兰兔(体重2.7～3.4 kg)用随机数字表法分为3组:假手术组(Sham组),ASCP组(S组),ASCP+高氧管理组(SH组),每组8只。术中检测动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、颈静脉球血氧分压(PjvO2)、颈静脉球血氧饱和度(SjvO2)和血乳酸(Lac)含量,术后检测脑组织SOD活性、MDA含量和脑组织含水量。结果停循环前、复灌前和复灌5 min SH组PaO2、PjvO2和SjvO2均高于S组和Sham组(P0.05)。SH组脑组织SOD活性与S组[(213.53±33.52)U/mg.prot vs.(193.02±27.67)U/mg.prot]和Sham组[(213.53±33.52)U/mg.prot vs.(244.38±35.02)U/mg.prot]比较差异无统计学意义(P0.05),但S组SOD活性低于Sham组(P0.05)。SH组脑组织MDA含量低于S组[(1.42±0.30)nmol/mg.prot vs.(2.37±0.55)nmol/mg.prot,P0.05]。结论深低温期间的高氧血气管理在DHCA+ASCP中能提供更好的氧供,有效地提高兔PjvO2和SjvO2,维持脑组织SOD活性,降低MDA含量,具有脑保护作用。     

The Response to Repeated Nitric Oxide Inhalation Is Inconsistent in Patients with Acute Respiratory Distress Syndrome

Background: Nitric oxide (NO) is administered frequently in patients with acute respiratory distress syndrome (ARDS) and pulmonary hypertension. The efficacy of this therapy over several days is not well known. The authors first determined the consistency of the response to repeated administration of NO and then the baseline variables that were associated with improvement in patients with severe ARDS.

Methods: In a prospective trial, 32 mechanically ventilated patients with severe ARDS received 10 parts per million NO by inhalation. In 22 of these patients, its effect was tested repeatedly (up to four times) in several days. Improvement was defined as an increase > 10% in the ratio of pressure of oxygen in arterial blood (PaO sub 2) to the inspiratory pressure of oxygen (FIO2) from baseline. Patients showing such an improvement were maintained on NO inhalation.

Results: Twelve of the 22 patients (54%) showed a clinically significant and reproducible increase in the PaO2 /FIO2 ratio with NO, from 74 +/- 30 mmHg (mean +/- SD) to 95 +/- 41 mmHg (P <0.001). In three patients (14%), PaO2 did not improve, even with multiple exposures. In seven patients (32%), an inconsistent response was seen on different days. Mean pulmonary artery pressure decreased for the entire group from 34 +/- 10 mmHg to 29 +/- 9 mmHg (P < 0.01), but this decrease did not correlate with the increase in PaO2 in individual patients. The baseline PaO2 /FIO2 ratio and mixed venous oxygenation (PvO2) were significantly lower, and the venous admixture was greater in patients showing beneficial effects of NO inhalation on PaO2.     

Treatment of Pulmonary Hypertension and Hypoxia Due to Oleic Acid Induced Lung Injury with Intratracheal Prostaglandin E1 during Partial Liquid Ventilation

Background: Partial liquid ventilation using perfluorocarbon liquids may be of therapeutic benefit in patients with acute respiratory failure. This study investigated the effects of prostaglandin E1 (PGE1) delivered intratracheally during partial liquid ventilation on lung function and pulmonary circulation in rabbits with acute respiratory distress syndrome.

Methods: Lung injury was induced by intravenous oleic acid in adult Japanese white rabbits, 1 h after which they were divided into four groups of 10 animals. Group 1 received mechanical ventilation alone, group 2 received aerosolized PGE1 (5 [micro sign]g followed by 0.1 [micro sign]g [middle dot] kg-1 [middle dot] min-1) under mechanical ventilation combined with 5 cm H2 O positive end-expiratory pressure, and groups 3 and 4 received partial liquid ventilation with 15 ml/kg perflubron. Group 4 received a 5-[micro sign]g bolus followed by 0.1 [micro sign]g [middle dot] kg-1 [middle dot] min-1 PGE1 instilled intratracheally (not by aerosol) in combination with partial liquid ventilation. Measurements were performed at 30-min intervals for 120 min after lung injury.

Results: After lung injury, hypoxemia, hypercapnia, acidosis, and pulmonary hypertension developed in all animals and were sustained in groups 1 and 2 throughout the experiment. The partial pressure of oxygen in arterial blood of animals in group 3 improved with initiation of treatment, with statistical significance achieved at the 30 and 60 min time points as compared with controls. Group 4 animals had immediate and sustained increases in the partial pressure of oxygen in arterial blood that were significant compared with all other groups during the experiment. Statistically significant reductions in mean pulmonary artery pressure were seen only in group 4 animals compared with all other groups.     

吸入一氧化氮对室间隔缺损手术后肺动脉高压的疗效观察

目的　观察吸入一氧化氮(nitricoxide,NO)治疗室间隔缺损 (ventricularseptaldefect,VSD)术后肺动脉高压 (pulmonaryhypertension ,PH)的疗效。 方法　 2 0例VSD术后PH病人分别吸入 2 0×10 -6 、6× 10 -6 NO ,监测吸入前后的血流动力学、氧合指标。结果　吸入 2 0× 10 -6 NO后明显降低肺动脉压、肺循环阻力、肺内分流率、肺泡动脉血氧分压差 ,提高动脉血氧分压、氧供指数 ;以上指标停吸NO后恢复吸入NO前水平 ;再吸入 6× 10 -6 NO后恢复吸入 2 0× 10 -6 NO后水平 ,并维持至停吸NO后。吸入前后体循环压及阻力无变化。结论　吸入NO是治疗VSD手术后PH的一种有效的方法。