Kerr C L, Veldhuizen R A, Lewis J F
Department of Physiology, Lawson Research Institute, St. Joseph's Health Centre, The University of Western Ontario, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada.
Am J Respir Crit Care Med. 2001 Jul 15;164(2):237-42. doi: 10.1164/ajrccm.164.2.2007144.
This study evaluated the effects of high-frequency oscillation (HFO) and conventional mechanical ventilation (CMV) on gas exchange and the pulmonary surfactant system in an acute lung injury model. Following induction of lung injury with N-nitroso-n-methylurethane, adult rabbits were anesthetized and randomized to one of the following ventilatory strategies: HFO for 120 min, CMV for 120 min, HFO for 60 min, followed by CMV for 60 min, CMV for 60 min followed by HFO for 60 min or CMV for 60 min. Separate animals were ventilated using CMV with a lower tidal volume and a positive end-expiratory pressure level that was increased throughout the experimental period. Oxygenation was significantly greater in animals ventilated with HFO compared with animals ventilated with CMV. The proportion of surfactant in large aggregate forms was significantly greater following ventilatory support with HFO compared with CMV. Surfactant aggregate conversion was also significantly lower during HFO compared with CMV. We conclude that in our model of acute lung injury, HFO was a superior mode of ventilation and reduced the conversion of alveolar surfactant large aggregates into small aggregate forms, resulting in a greater percentage of large aggregate forms in the alveolar space.
本研究在急性肺损伤模型中评估了高频振荡通气（HFO）和传统机械通气（CMV）对气体交换及肺表面活性物质系统的影响。用N-亚硝基-N-甲基脲诱导肺损伤后，成年兔麻醉并随机分为以下通气策略之一：HFO通气120分钟、CMV通气120分钟、HFO通气60分钟后接CMV通气60分钟、CMV通气60分钟后接HFO通气60分钟或CMV通气60分钟。另外的动物采用低潮气量及在整个实验期间逐渐增加呼气末正压水平的CMV进行通气。与采用CMV通气的动物相比，采用HFO通气的动物氧合显著更好。与CMV相比，HFO通气支持后大聚集体形式的表面活性物质比例显著更高。与CMV相比，HFO期间表面活性物质聚集体转化率也显著更低。我们得出结论，在我们的急性肺损伤模型中，HFO是一种更优的通气模式，可减少肺泡表面活性物质大聚集体向小聚集体形式的转化，导致肺泡腔内大聚集体形式的比例更高。
