Pison U, Seeger W, Buchhorn R, Joka T, Brand M, Obertacke U, Neuhof H, Schmit-Neuerburg K P
Department of Trauma-Surgery, University of Essen, Federal Republic of Germany.
Am Rev Respir Dis. 1989 Oct;140(4):1033-9. doi: 10.1164/ajrccm/140.4.1033.
We present a prospective study, designed to evaluate surfactant abnormalities in severely injured patients during the course of post-traumatic pulmonary dysfunction. Serially obtained bronchoalveolar lavage fluids from noncontused lung areas (in total, 132 samples from 17 patients) were analyzed for alveolar phospholipid composition and surfactant function in vitro during the first 14 days after trauma. The data were compared with those of 29 lavage samples obtained from 10 healthy control subjects and correlated to severity of respiratory failure. In the traumatized patients, the total lavage phospholipid content was unchanged, but there was a progressive decrease in the relative amounts of phosphatidylcholine (%PC) and phosphatidylglycerol and an increase in phosphatidylinositol, phosphatidylethanolamine, and sphingomyelin. These alterations were paralleled by a marked decrease in the hysteresis area of the surface tension isotherm. The decrease in %PC and reduction of hysteresis area were significantly correlated. The alterations in alveolar phospholipid composition and in vitro surfactant function were more pronounced in patients with severe respiratory failure. There was a significant inverse correlation between severity of respiratory dysfunction and %PC or hysteresis area for all traumatized patients. Protein leakage into the alveolar space was significantly higher in patients with severe respiratory failure and appeared to precede surfactant abnormalities in such patients. The neutrophil content in the alveolar space was markedly increased in all patients with multiple injuries however, no significant correlation with the noted alterations in alveolar phospholipid composition or surfactant function was found. We concluded that surfactant abnormalities occur during the course of post-traumatic pulmonary dysfunction and are correlated with the severity of respiratory failure.
我们开展了一项前瞻性研究，旨在评估严重创伤患者创伤后肺功能障碍过程中的表面活性剂异常情况。在创伤后的前14天内，对从非挫伤肺区域连续获取的支气管肺泡灌洗液体（共来自17例患者的132份样本）进行体外肺泡磷脂成分和表面活性剂功能分析。将这些数据与从10名健康对照受试者获取的29份灌洗样本的数据进行比较，并与呼吸衰竭的严重程度相关联。在创伤患者中，灌洗总磷脂含量未变，但磷脂酰胆碱（%PC）和磷脂酰甘油的相对含量逐渐下降，而磷脂酰肌醇、磷脂酰乙醇胺和鞘磷脂增加。这些改变伴随着表面张力等温线滞后面积的显著减小。%PC的降低与滞后面积的减小显著相关。肺泡磷脂成分和体外表面活性剂功能的改变在严重呼吸衰竭患者中更为明显。对于所有创伤患者，呼吸功能障碍的严重程度与%PC或滞后面积之间存在显著负相关。严重呼吸衰竭患者肺泡腔内蛋白质渗漏显著更高，且在此类患者中似乎先于表面活性剂异常出现。所有多发伤患者肺泡腔内中性粒细胞含量均显著增加，然而，未发现其与肺泡磷脂成分或表面活性剂功能的上述改变有显著相关性。我们得出结论，表面活性剂异常发生在创伤后肺功能障碍过程中，且与呼吸衰竭的严重程度相关。
