Buchman S R, Sugerman H J, Tatum J L, Wright T P, Blocher C R, Hirsch J I
Surgery. 1984 Aug;96(2):163-70.
The purpose of this study was to examine the effects of methylprednisolone (MP), ibuprofen (I), and prostacyclin (PGI2) pretreatment on cardiopulmonary hemodynamics, arterial oxygenation, and pulmonary alveolar-capillary membrane permeability, measured with a gamma-scintigraphic technique, after acid instillation in the dog. All animals were placed on their right side and 2 ml/kg 0.1 N HCl was instilled into the endotracheal tube. Five untreated control dogs showed a significant (p less than 0.05) rise in slope index (SI), a scintigraphic measurement of pulmonary albumin flux, 30 minutes after acid injury. After 120 minutes there was a significant rise in mean pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR) and a decrease (p less than 0.05) in cardiac output (CO) and PaO2. Two groups of five dogs each were pretreated with MP (30 mg/kg) and I (12.5 mg/kg), respectively. Thirty minutes after acid instillation both groups showed a significant rise in the SI, which was significantly greater than the values in the control animals in the case of MP. By 120 minutes after acid injury all changes in PAP, PVR, PaO2, and CO were not significantly different from those of control animals with the exception of the I group, which resisted any change in CO throughout the study. Another group of five dogs were pretreated with a constant infusion of PGI2 (3 micrograms/kg/min) starting 75 minutes before acid instillation. PGI2 produced a significant increase in CO that was also greater (p less than 0.05) than the CO in control animals before instillation of HCl. Pre-HCl SI in the dogs treated with PGI2 was slightly, but significantly, increased over control dogs. The SI and CO remained significantly higher than values in control animals 30 minutes after acid injury. The SI remained significantly higher than that of control animals at 120 minutes. After 2 hours changes in PAP, PVR, PaO2, and CO were without significant difference from those of control animals. These data support the conclusion that PGI2, I, or MP are not effective therapy for acid aspiration and that PGI2 and I may worsen the protein leak by increasing flow across the damaged capillary membrane.
本研究的目的是，在用伽马闪烁照相技术测量犬酸灌注后，检测甲基泼尼松龙（MP）、布洛芬（I）和前列环素（PGI2）预处理对心肺血流动力学、动脉氧合以及肺泡 - 毛细血管膜通透性的影响。所有动物右侧卧位，将2 ml/kg的0.1 N盐酸经气管内导管滴注。五只未治疗的对照犬在酸损伤30分钟后，斜率指数（SI，肺白蛋白通量的闪烁照相测量值）显著升高（p < 0.05）。120分钟后，平均肺动脉压（PAP）和肺血管阻力（PVR）显著升高，心输出量（CO）和动脉血氧分压（PaO2）降低（p < 0.05）。两组各五只犬分别用MP（30 mg/kg）和I（12.5 mg/kg）预处理。酸灌注30分钟后，两组的SI均显著升高，其中MP组显著高于对照动物的值。酸损伤120分钟后，除I组在整个研究过程中心输出量无任何变化外，PAP、PVR、PaO2和CO的所有变化与对照动物无显著差异。另一组五只犬在酸灌注前75分钟开始持续输注PGI2（3微克/千克/分钟）进行预处理。PGI2使心输出量显著增加，且也高于盐酸灌注前对照动物的心输出量（p < 0.05）。PGI2处理犬的酸灌注前SI较对照犬略有但显著升高。酸损伤30分钟后，SI和心输出量仍显著高于对照动物的值。120分钟时，SI仍显著高于对照动物。2小时后，PAP、PVR、PaO2和CO的变化与对照动物无显著差异。这些数据支持以下结论：PGI2、I或MP对误吸酸不是有效的治疗方法，并且PGI2和I可能通过增加受损毛细血管膜的血流量而使蛋白质渗漏恶化。
