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吲哚美辛对油酸诱导的肺水肿中分流及其对呼气末正压通气的反应有影响吗?

Does indomethacin affect shunt and its response to PEEP in oleic acid pulmonary edema?

作者信息

Ali J, Duke K

出版信息

J Appl Physiol (1985). 1987 Jun;62(6):2187-92. doi: 10.1152/jappl.1987.62.6.2187.

Abstract

We assessed hemodynamics, lobar perfusion, and shunts at base line 1.5 h after unilobar oleic acid edema, 15 min after indomethacin (10 mg/kg iv), and 15 min after positive end-expiratory pressure (PEEP) (10 cm) in 10 dogs. In 10 additional dogs (control) the same measurements were made but no indomethacin was administered. Shunts of the edematous lobe were: 10.6 +/- 6.3, 54.1 +/- 22.8, 30.8 +/- 16.6, and 12.4 +/- 6.3% for dogs administered indomethacin and 10.9 +/- 4.2, 53.8 +/- 13.1, 72.3 +/- 14.6, and 11.5 +/- 4.1% for the controls. Perfusions (% cardiac output) to the edematous lobe were 27.6 +/- 3.6, 14.6 +/- 2.0, 9.9 +/- 1.5, and 27.9 +/- 2.9% in the dogs administered indomethacin and 27.3 +/- 3.1, 14.0 +/- 1.7, 13.2 +/- 1.3, and 26.9 +/- 2.8% in controls. The decrease in lobar perfusion was similar before indomethacin with a further decrease in lobar perfusion and an increase in lobar vascular resistance 15 min after indomethacin. The increase in vascular resistance of the edematous lobe was three times that of nonedematous lobes after indomethacin (149.6 +/- 76% vs. 58.0 +/- 43%). Indomethacin, therefore, decreases shunt possibly by enhancing alveolar hypoxic vasoconstriction and does not block the improvement in shunt with PEEP.

摘要

我们在10只犬身上评估了单叶油酸水肿后1.5小时、静脉注射吲哚美辛(10mg/kg)后15分钟以及呼气末正压(PEEP)(10cm水柱)后15分钟时的血流动力学、肺叶灌注和分流情况。另外10只犬(对照组)进行了相同测量,但未给予吲哚美辛。给予吲哚美辛的犬水肿肺叶的分流率分别为:10.6±6.3%、54.1±22.8%、30.8±16.6%和12.4±6.3%;对照组分别为10.9±4.2%、53.8±13.1%、72.3±14.6%和11.5±4.1%。给予吲哚美辛的犬水肿肺叶的灌注(占心输出量的百分比)分别为27.6±3.6%、14.6±2.0%、9.9±1.5%和27.9±2.9%;对照组分别为27.3±3.1%、14.0±1.7%、13.2±1.3%和26.9±2.8%。吲哚美辛使用前肺叶灌注的降低情况相似,使用吲哚美辛15分钟后肺叶灌注进一步降低,肺叶血管阻力增加。吲哚美辛使用后,水肿肺叶的血管阻力增加是非水肿肺叶的三倍(149.6±76%对58.0±43%)。因此,吲哚美辛可能通过增强肺泡低氧性血管收缩来降低分流,并且不会阻碍PEEP对分流的改善作用。

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