气管内气体吹入联合部分液体通气治疗幼猪脂多糖诱导的急性肺损伤。

Tracheal gas insufflation with partial liquid ventilation to treat LPS-induced acute lung injury in juvenile piglets.

机构信息

Department of Respiratory Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China.

出版信息

Pediatr Pulmonol. 2010 Jul;45(7):700-7. doi: 10.1002/ppul.21257.

DOI:10.1002/ppul.21257

PMID:20672361

Abstract

OBJECTIVES

Partial liquid ventilation (PLV) with perfluorocarbons (PFC) seems not superior to conventional ventilation clinically. We hypothesized that a combination of continuous tracheal gas insufflation (TGI) with protective strategy of PLV (low dose of PFC, low inflation pressure, moderate inhalation of oxygen and moderate anesthesia) would improve cardiopulmonary function in acute lung injury.

METHODS

Twenty-four healthy juvenile piglets were anesthetized and mechanically ventilated at PEEP of 2 cmH(2)O with a peak inspiratory pressure of 10 cmH(2)O and FIO(2) of 0.4. The piglets were challenged with lipopolysaccharide and randomly assigned to four groups (n = 6 each): (1) mechanical ventilation alone (MV); (2) PLV with perfluorodecalin (10 ml/kg); (3) TGI with continuous airway flow 2 L/min; and (4) combination of PLV and TGI. The outcome was assessed functionally and histologically.

RESULTS

All treatments except MV improved pH, PaO(2)/FIO(2), PaCO(2), ventilation efficacy index (VEI) and tidal volume. Both PLV-associated treatments also improved heart rate, respiratory rate, pulse contour cardiac output, systemic vascular resistance, dynamic lung compliance, mean airway resistance and mean airway pressure. The combination group resulted in higher PaO(2)/FIO(2), VEI and a better lung histology score than any other treatments.

CONCLUSIONS

The new protective strategy may provide a better treatment for sepsis-induced acute lung injury.

摘要

目的

含氟碳化合物（PFC）的部分液体通气（PLV）在临床上似乎并不优于常规通气。我们假设，连续气管内气体吹入（TGI）与 PLV 的保护策略（低剂量 PFC、低充气压力、适度吸氧和适度麻醉）相结合，将改善急性肺损伤的心肺功能。

方法

24 只健康的幼年猪在呼气末正压（PEEP）为 2cmH₂O、吸气峰压为 10cmH₂O 和吸入氧分数（FIO₂）为 0.4 的情况下进行麻醉和机械通气。猪被脂多糖攻击，并随机分为四组（每组 n = 6）：（1）单独机械通气（MV）；（2）用全氟癸烷（10ml/kg）进行 PLV；（3）以 2L/min 的连续气道流量进行 TGI；和（4）PLV 和 TGI 的组合。通过功能和组织学评估结果。

结果

除 MV 外，所有治疗方法均改善了 pH、PaO₂/FIO₂、PaCO₂、通气效率指数（VEI）和潮气量。PLV 相关的两种治疗方法也改善了心率、呼吸频率、脉搏轮廓心输出量、全身血管阻力、动态肺顺应性、平均气道阻力和平均气道压力。与其他任何治疗方法相比，联合组的 PaO₂/FIO₂、VEI 和肺组织学评分更高。