全氟化碳雾化吸入对急性呼吸窘迫综合征猪气体交换、呼吸力学和血流动力学的影响

目的探讨全氟化碳(PFC)雾化吸入对急性呼吸窘迫综合征(ARDS)猪气体交换、呼吸力学和血流动力学的影响。方法16只通过气管内吸入十六烷磺基丁二酸钠(DTG)制作的ARDS模型猪随机分为PFC治疗组和对照组。PFC治疗组在常规机械通气基础上,连接雾化器,以纯氧(氧流速3L/min)作为驱动气流推动雾化PFC治疗2h(7～8ml·kg-1·h-1);对照组在常规机械通气基础上,连接雾化器单独给予纯氧治疗2h(氧流速3L/min),在治疗期间每间隔15min测定动脉血气、血压、心率及平台压、顺应性、呼出潮气量和内源性呼气末正压(PEEPi),观察两组动物气体交换、呼吸力学和血流动力学参数的变化。结果DTG气管内吸入1h后,PFC治疗组动脉血氧分压(PaO2)从(377±55)mmHg(1mmHg=0.133kPa)下降至(56±13)mmHg[吸入气氧浓度(FiO2)100%],对照组PaO2从(383±53)mmHg下降至(49±12)mmHg(FiO2100%);PFC治疗组顺应性从(3.7±1.0)ml/cmH2O下降至(1.5±0.4)ml/cmH2O,对照组顺应性从(3.8±0.7)ml/cmH2O下降至(1.4±0.4)ml/cmH2O。PFC治疗2h后PFC治疗组PaO2上升至(189±133)mmHg,顺应性改善至(4.1±1.4)ml/cmH2O,呼出潮气量增加至(74.5±16.9)ml;对照组PaO2上升至(83±51)mmHg,顺应性改善至(2.8±1.8)ml/cmH2O,呼出潮气量增加至(50.1±4.1)ml;两组比较差异均有统计学意义(P均<0.05)。两组动物pH值、心率、血压、平台压、PEEPi和动脉血二氧化碳分压(PaCO2)比较差异均无统计学意义(P均>0.05)。结论PFC雾化吸入能明显改善ARDS家猪的氧合,提高损伤肺的顺应性,增加呼出潮气量。

Effects of aerosolized perfluorocarbon on gas exchange,respiratory mechanics and hemodynamics in a swine model of acute respiratory distress syndrome

OBJECTIVE: To investigate the effects of aerosolized perfluorocarbon (PFC) on gas exchanges, respiratory mechanics and hemodynamics in a swine model of acute respiratory distress syndrome (ARDS). METHODS: ARDS was induced by intratracheal instillation of detergent in 16 piglets, and the animals were then randomly assigned to a PFC treated group (n = 8) and a control group (n = 8). Animals of the control group were gas-ventilated with 100% O2 (3 L/min), while those of the PFC treated group received an additional continuous aerosolized PFC at 7 - 8 ml.kg(-1).h(-1). Blood gases, average artery pressure, heart rate, platform pressure, compliance, expiratory tidal volume and intrinsic positive end-expiratory pressure (PEEPi) were measured per 15 minutes. RESULTS: Detergent instillation resulted in a marked decrease in arterial oxygen pressure (PaO2) within 60 min, from (383 +/- 53) mm Hg (1 mm Hg = 0.133 kPa) to (49 +/- 12) mm Hg in the control group [fraction of inspired oxygen (FiO2) 100%], and from (377 +/- 55) mm Hg to (56 +/- 13) mm Hg in the PFC group (FiO2 100%). After 2 h treatment, PaO2 was increased from (49 +/- 12) mm Hg to (83 +/- 51) mm Hg in the control group, compliance from (1.4 +/- 0.4) ml/cm H2O to (2.8 +/- 1.8) ml/cm H2O, and expiratory tidal volume from (30.8 +/- 5.5) ml to (50.1 +/- 4.1) ml in the control group; PaO2 from (56 +/- 13) mm Hg to (189 +/- 133) mm Hg, compliance from (1.5 +/- 0.4) ml/cm H2O to (4.1 +/- 1.4) ml/cm H2O, and expiratory tidal volume from (30.8 +/- 3.3) ml to (74.5 +/- 16.9) ml in the PFC group (all P < 0.05). There were no significant differences between groups in arterial carbon dioxide pressure (PaCO2), pH values, blood pressure, heart rates, plat pressure and PEEPi during treatment (all P > 0.05). CONCLUSION: It is suggested that aerosolized PFC increases arterial oxygenation, compliance, and expiratory tidal volume in extended detergent-induced ARDS.