肺泡表面活性物质灌洗对家兔急性盐酸肺损伤后血气及气道压力的治疗效果研究

目的:探索采用肺泡表面活性物质肺灌洗的方法治疗盐酸诱导家兔急性肺损伤的疗效。方法:家兔麻醉后纯氧机械通气15min,经气管导管注入0.0125mol/L的HCL12ml/kg,造成急性肺损伤。随后观察150min,将PaO2低于150mmHg(1mmHg=0.133kPa)的动物随机分为4组,每组5只。分别采用肺泡表面活性物质灌洗(L组),肺泡表面活性物质注入(I组),生理盐水灌洗(S组)和机械通气(M组)处理,测定处理后30、60、120、180、240min时的血气值及气道峰压值(PIP)。结果:L组PaO2在处理后立即上升到400mmHg以上(P<0.01),并维持整个4h观察期。气道峰压明显下降(P<0.01),120min后有所上升,但仍较处理前降低(P<0.05);Ⅰ组PaO2平均上升至200mmHg但随后逐渐下降伴PIP明显升高(P<0.05)。M组和S组血气无明显改善,M组气道峰压维持在处理前水平,S组120min后气道峰压明显升高(P<0.05)。结论:采用肺泡表面活性物质灌洗法治疗盐酸误吸性急性肺损伤是一种有前景的治疗方法。

The Treatment Efficacy of Lavage Administration of Pulmonary Surfactant on Rabbits with Acute Lung Injury Induced by Hydrochloric Acid

Objective:To investigate the effect of lavage administration of pu lmonary surfactant on rabbits with acute lung injury induced by hydrochloric aci d. Methods:After the rabbits were anesthetized, tracheotomy were performed and 0.0125mol/L hydrochloric acid (12 ml/kg) was instilled into lungs via endotrache al tube. The rabbits with PaO2 under 150mmHg were randomly divided into four gro ups, with 5 in each group. The pulmonary surfactant (15ml/kg ,12 g/L) was inject ed via the tracheal tube and drained thereafter in the lavage group (L group). T he same volume of saline was used to substitute the pulmonary surfactant in the saline group (S group). The pulmonary surfactant (4 ml/kg, 45 g/L) was given in the instillation group (I group), and neither saline or pulmonary surfactant was given in the mechanical ventilation group (M group). Results:In L group the Pa O2 dramatically increased from below 100mmHg to above 400mmHg at 30min after lav age (P< 0.01), and maintained thereafter through whole observation period (4 hou rs). The PIP decreased markedly (P< 0.01) soon after the lungs were lavaged but gradually increased a little thereafter. The PaO2 increased to 200mmHg at 30min after the pulmonary surfactant was tracheally instilled in the I group (P< 0.05) , and then decreased to the level before the pulmonary surfactant was delivered. In M and S groups, the blood gases and PIP showed no improvement during the obs ervation period. Conclusion: Lavage administration of pulmonary surfactant seems to be a promising method in the treatment of acute lung injury induced by hydro chloric acid.