Sznajder J I, Zucker A R, Wood L D, Long G R
Am Rev Respir Dis. 1986 Aug;134(2):222-8. doi: 10.1164/arrd.1986.134.2.222.
Aspiration of hydrochloric acid causes pulmonary capillary endothelial damage and edema. One approach to treatment is reduction of circulating volume and pulmonary wedge pressure (Ppw) to low values compatible with adequate cardiac output (QT) and oxygen delivery (QO2) to the tissues. We investigated this approach in 18 dogs after intratracheal instillation of HCl. One hour after injury, animals were randomized into 3 equal groups and studied for another 4 h. Control dogs (Group C) were maintained at a Ppw of 12 mmHg throughout the experiment. In a second group (Group H), Ppw was reduced over 30 min to 5 mmHg by hemofiltration and maintained at this amount throughout the experiment. In a third group (Group P) Ppw was reduced and maintained at 5 mmHg by plasmapheresis. In Group C, extravascular thermal volume (ETV), measured in vivo, increased to 520 ml by 5 h, and venous admixture (QVA/QT) increased to 30%. In contrast, plasmapheresis stopped ETV accumulation at the 1-h value of 250 ml, whereas QVA/QT decreased to 8% at 5 h. Hemofiltration did not significantly reduce either ETV or QVA/QT, which were 420 ml and 30%, respectively, at 5 h. The wet weights of lungs excised at 5 h and normalized to body weight (WW/BW) confirmed that plasmapheresis reduced edema (WW/BW, 19 ml/kg) compared (p less than 0.05 ANOVA) with that in the control group (WW/BW, 27), and that hemofiltration did not significantly reduce edema (WW/BW, 24).(ABSTRACT TRUNCATED AT 250 WORDS)
吸入盐酸会导致肺毛细血管内皮损伤和水肿。一种治疗方法是将循环血容量和肺楔压（Ppw）降低至与足够的心输出量（QT）和组织氧输送量（QO2）相适应的低水平。我们在18只气管内滴注盐酸的犬身上研究了这种方法。损伤后1小时，将动物随机分为3组，每组6只，再研究4小时。对照组犬（C组）在整个实验过程中Ppw维持在12 mmHg。第二组（H组）通过血液滤过在30分钟内将Ppw降至5 mmHg，并在整个实验过程中维持该水平。第三组（P组）通过血浆置换将Ppw降低并维持在5 mmHg。在C组，体内测量的血管外热容量（ETV）在5小时时增加到520 ml，静脉混合血（QVA/QT）增加到30%。相比之下，血浆置换使ETV在1小时时的250 ml值处停止积累，而QVA/QT在5小时时降至8%。血液滤过未显著降低ETV或QVA/QT，5小时时分别为420 ml和30%。5小时时切除的肺组织湿重经体重标准化后（WW/BW）证实，与对照组（WW/BW，27）相比，血浆置换减轻了水肿（WW/BW，19 ml/kg）（方差分析p<0.05），而血液滤过未显著减轻水肿（WW/BW，24）。（摘要截短至250字）
