Hartog A, Vazquez de Anda G F, Gommers D, Kaisers U, Verbrugge S J, Schnabel R, Lachmann B
Department of Anaesthesiology, Erasmus University Rotterdam, The Netherlands.
Br J Anaesth. 1999 Jan;82(1):81-6. doi: 10.1093/bja/82.1.81.
We have compared three treatment strategies, that aim to prevent repetitive alveolar collapse, for their effect on gas exchange, lung mechanics, lung injury, protein transfer into the alveoli and surfactant system, in a model of acute lung injury. In adult rats, the lungs were ventilated mechanically with 100% oxygen and a PEEP of 6 cm H2O, and acute lung injury was induced by repeated lung lavage to obtain a PaO2 value < 13 kPa. Animals were then allocated randomly (n = 12 in each group) to receive exogenous surfactant therapy, ventilation with high PEEP (18 cm H2O), partial liquid ventilation or ventilation with low PEEP (8 cm H2O) (ventilated controls). Blood-gas values were measured hourly. At the end of the 4-h study, in six animals per group, pressure-volume curves were constructed and bronchoalveolar lavage (BAL) was performed, whereas in the remaining animals lung injury was assessed. In the ventilated control group, arterial oxygenation did not improve and protein concentration of BAL and conversion of active to non-active surfactant components increased significantly. In the three treatment groups, PaO2 increased rapidly to > 50 kPa and remained stable over the next 4 h. The protein concentration of BAL fluid increased significantly only in the partial liquid ventilation group. Conversion of active to non-active surfactant components increased significantly in the partial liquid ventilation group and in the group ventilated with high PEEP. In the surfactant group and partial liquid ventilation groups, less lung injury was found compared with the ventilated control group and the group ventilated with high PEEP. We conclude that although all three strategies improved PaO2 to > 50 kPa, the impact on protein transfer into the alveoli, surfactant system and lung injury differed markedly.
在急性肺损伤模型中，我们比较了三种旨在预防反复肺泡萎陷的治疗策略，观察它们对气体交换、肺力学、肺损伤、蛋白质转运至肺泡及表面活性剂系统的影响。在成年大鼠中，用100%氧气和6 cm H₂O的呼气末正压（PEEP）进行机械通气，通过反复肺灌洗诱导急性肺损伤，使动脉血氧分压（PaO₂）值<13 kPa。然后将动物随机分组（每组n = 12），分别接受外源性表面活性剂治疗、高PEEP（18 cm H₂O）通气、部分液体通气或低PEEP（8 cm H₂O）通气（通气对照组）。每小时测量血气值。在4小时研究结束时，每组6只动物构建压力-容积曲线并进行支气管肺泡灌洗（BAL），其余动物评估肺损伤情况。在通气对照组中，动脉氧合未改善，BAL液中的蛋白质浓度及活性表面活性剂成分向非活性成分的转化显著增加。在三个治疗组中，PaO₂迅速升至>50 kPa，并在接下来的4小时内保持稳定。仅在部分液体通气组中，BAL液中的蛋白质浓度显著增加。在部分液体通气组和高PEEP通气组中，活性表面活性剂成分向非活性成分的转化显著增加。与通气对照组和高PEEP通气组相比，表面活性剂组和部分液体通气组的肺损伤较轻。我们得出结论，尽管所有三种策略均使PaO₂提高至>50 kPa，但它们对蛋白质转运至肺泡、表面活性剂系统及肺损伤的影响明显不同。
