Wilcox D T, Glick P L, Karamanoukian H L, Leach C, Morin F C, Fuhrman B P
Buffalo Institute of Fetal Therapy, Children's Hospital of Buffalo, NY, USA.
Crit Care Med. 1995 Nov;23(11):1858-63. doi: 10.1097/00003246-199511000-00012.
To determine the efficacy of perfluorocarbon-associated gas exchange and the effects of inhaled nitric oxide during perfluorocarbon-associated gas exchange in the congenital diaphragmatic hernia lamb model.
Prospective, nonrandomized, controlled, nonhuman trial.
Animal research facility.
Fetal lambs of 16 time-dated pregnant ewes, at 80 days gestation (term 140 to 145 days).
The congenital diaphragmatic hernia lamb model was created in 16 animals. Twelve animals survived to be studied. All animals were mechanically ventilated for 4 hrs with a time-cycled, pressure-limited ventilator. Perfluorocarbon-associated gas exchange was started after 15 mins of ventilation (n = 6). Blood gases were analyzed at 30 mins and then hourly. The perfluorocarbon-associated gas exchange animals had dynamic compliance and tidal volumes measured. After 1 hr, inhaled nitric oxide (80 parts per million) was delivered to the perfluorocarbon-associated gas exchange animals for 10 mins. All blood gas parameters, including pH (6.72 +/- 0.06 vs. 7.14 +/- 0.07), PCO2 (186 +/- 12 vs. 70.5 +/- 16.7 torr [24.8 +/- 1.6 vs. 9.5 +/- 2.1 kPa]), and PO2 (48 +/- 17 vs. 156 +/- 48 torr [6.4 +/- 2.3 vs. 20.8 +/- 6.4 kPa]) were significantly improved in the perfluorocarbon-associated gas exchange-treated group at 4 hrs (p < .005). Dynamic compliance (0.13 +/- 0.02 vs. 0.32 +/- 0.06 mL/cm H2O/kg) and tidal volume (3.5 +/- 0.35 vs. 7.22 +/- 0.61 mL/kg) were also significantly (p < .001) increased in the perfluorocarbon-associated gas exchange group. In the perfluorocarbon-associated gas exchange animals, nitric oxide caused a significant (p < .05) increase in oxygenation and a reduction in pulmonary hypertension. This effect was reversed by stopping the inhaled nitric oxide.
Perfluorocarbon-associated gas exchange significantly improved gas exchange, dynamic compliance, and tidal volumes. Furthermore, inhaled nitric oxide can be effectively delivered during perfluorocarbon-associated gas exchange to reduce pulmonary hypertension and enhance oxygenation.
在先天性膈疝羔羊模型中确定全氟化碳相关气体交换的疗效以及吸入一氧化氮在全氟化碳相关气体交换过程中的作用。
前瞻性、非随机、对照、非人体试验。
动物研究设施。
16只怀孕母羊的胎羊，妊娠80天（足月为140至145天）。
在16只动物中建立先天性膈疝羔羊模型。12只动物存活下来接受研究。所有动物均使用定时、压力限制通气机进行机械通气4小时。通气15分钟后开始全氟化碳相关气体交换（n = 6）。在30分钟时分析血气，然后每小时分析一次。对进行全氟化碳相关气体交换的动物测量动态顺应性和潮气量。1小时后，向进行全氟化碳相关气体交换的动物输送吸入一氧化氮（百万分之80）10分钟。在4小时时，全氟化碳相关气体交换治疗组的所有血气参数，包括pH值（6.72±0.06对7.14±0.07）、PCO₂（186±12对70.5±16.7托[24.8±1.6对9.5±2.1千帕]）和PO₂（48±17对156±48托[6.4±2.3对20.8±6.4千帕]）均有显著改善（p <.005）。全氟化碳相关气体交换组的动态顺应性（0.13±0.02对0.32±0.06毫升/厘米水柱/千克）和潮气量（3.5±0.35对7.22±0.61毫升/千克）也显著增加（p <.001）。在进行全氟化碳相关气体交换的动物中，一氧化氮使氧合显著增加（p <.05）并降低肺动脉高压。停止吸入一氧化氮后这种作用逆转。
全氟化碳相关气体交换显著改善了气体交换、动态顺应性和潮气量。此外，在全氟化碳相关气体交换过程中可有效输送吸入一氧化氮以降低肺动脉高压并增强氧合。
