Eijking E P, Gommers D, So K L, Vergeer M, Lachmann B
Department of Anesthesiology, Erasmus University, Rotterdam, The Netherlands.
Anesthesiology. 1993 Jun;78(6):1145-51. doi: 10.1097/00000542-199306000-00019.
The surfactant system seems to be involved in the pathophysiology of respiratory failure caused by hydrochloric acid (HCl) aspiration. This study was an investigation of the effect of different treatment strategies using an exogenous surfactant preparation on lung function of rats suffering from respiratory failure after intratracheal HCl instillation.
In rats anesthetized with halothane, nitrous oxide, and oxygen, tracheotomy was performed and the lungs were mechanically ventilated. Respiratory failure was induced by intratracheal instillation of HCl (0.1 N, 3 ml/kg). After the PaO2 decreased to < 200 mmHg, the animals were randomly divided into five groups. Group I received no treatment; group II received a natural surfactant preparation intratracheally (200 mg/kg); group III underwent bronchoalveolar lavage (BAL) with saline, followed by surfactant treatment (200 mg/kg); and groups IV and V underwent BAL with saline and a diluted surfactant suspension (3.3 mg/ml in 30 ml/kg), respectively. Groups IV and V received a second and third BAL 60 and 120 min after the first lavage. Blood gas analysis and protein measurements in BAL fluids were performed.
Gas exchange improved in Groups III and V only. Protein concentrations were high in all BAL fluids. In the rats receiving BAL three times (groups IV and V), a decrease in protein concentration was observed.
From these results, it was concluded that plasma-derived proteins (which are known to inhibit surfactant function) are washed out of the alveoli by BAL, resulting in improved efficacy of surfactant treatment.
表面活性剂系统似乎参与了盐酸（HCl）误吸所致呼吸衰竭的病理生理过程。本研究旨在探讨使用外源性表面活性剂制剂的不同治疗策略对气管内滴注HCl后发生呼吸衰竭的大鼠肺功能的影响。
用氟烷、氧化亚氮和氧气麻醉大鼠，行气管切开术并进行机械通气。通过气管内滴注HCl（0.1N，3ml/kg）诱导呼吸衰竭。当动脉血氧分压（PaO2）降至<200mmHg后，将动物随机分为五组。第一组不接受治疗；第二组经气管内给予天然表面活性剂制剂（200mg/kg）；第三组先用生理盐水进行支气管肺泡灌洗（BAL），然后给予表面活性剂治疗（200mg/kg）；第四组和第五组分别先用生理盐水和稀释的表面活性剂混悬液（3.3mg/ml，30ml/kg）进行BAL。第四组和第五组在第一次灌洗后60分钟和120分钟分别接受第二次和第三次BAL。进行血气分析和BAL液中的蛋白质测定。
仅第三组和第五组的气体交换得到改善。所有BAL液中的蛋白质浓度均较高。在接受三次BAL的大鼠（第四组和第五组）中，观察到蛋白质浓度降低。
从这些结果得出结论，血浆来源的蛋白质（已知可抑制表面活性剂功能）通过BAL从肺泡中洗出，从而提高了表面活性剂治疗的效果。
