Mrozek J D, Smith K M, Bing D R, Meyers P A, Simonton S C, Connett J E, Mammel M C
Infant Pulmonary Research Center, Children's Health Care-St. Paul, Minnesota 55102, USA.
Am J Respir Crit Care Med. 1997 Oct;156(4 Pt 1):1058-65. doi: 10.1164/ajrccm.156.4.9610104.
We compared the effects of surfactant and partial liquid ventilation (PLV), and the impact of administration order, on oxygenation, respiratory system compliance (Crs), hemodynamics, and lung pathology in an animal lung injury model. We studied four groups: surfactant alone (S; n = 8); partial liquid ventilation alone (PLV-only; n = 8); surfactant followed by partial liquid ventilation (S-PLV; n = 8); and partial liquid ventilation-followed by surfactant (PLV-S; n = 8). Following treatments, all animals had improved oxygenation index (OI) and Crs. Animals in PLV groups showed continued improvement over 2 h (% change OI: PLV-S -83% versus S -47%, p < 0.05; % change Crs: S-PLV 73% versus S 13%, p < 0.05). We also saw administration-order effects: surfactant before PLV improved Crs (0.92 ml/cm H2O after surfactant versus 1.13 ml/cm H2O after PLV, p < 0.02) without changing OI, whereas surfactant after PLV did not change Crs and OI increased (5.01 after PLV versus 8.92 after surfactant, p < 0.03). Hemodynamics were not different between groups. Pathologic analysis demonstrated decreased lung injury in dependent lobes of all PLV-treated animals, and in all lobes of S-PLV animals, when compared with the lobes of the S animals (p < 0.05). We conclude that surfactant therapy in combination with PLV improved oxygenation, respiratory system mechanics, and lung pathology to a greater degree than surfactant therapy alone. Administration order affected initial physiologic response and ultimate pathology: surfactant given before PLV produced the greatest improvements in pathologic outcomes.
我们在动物肺损伤模型中比较了表面活性剂和部分液体通气（PLV）的效果，以及给药顺序对氧合、呼吸系统顺应性（Crs）、血流动力学和肺病理学的影响。我们研究了四组：单独使用表面活性剂（S组；n = 8）；单独使用部分液体通气（仅PLV组；n = 8）；先使用表面活性剂后进行部分液体通气（S-PLV组；n = 8）；以及先进行部分液体通气后使用表面活性剂（PLV-S组；n = 8）。治疗后，所有动物的氧合指数（OI）和Crs均有所改善。PLV组的动物在2小时内持续改善（OI变化百分比：PLV-S组为-83%，S组为-47%，p < 0.05；Crs变化百分比：S-PLV组为73%，S组为13%，p < 0.05）。我们还观察到给药顺序的影响：在PLV之前使用表面活性剂可改善Crs（表面活性剂后为0.92 ml/cm H2O，PLV后为1.13 ml/cm H2O，p < 0.02），而OI不变，而在PLV之后使用表面活性剂则不会改变Crs，且OI增加（PLV后为5.01，表面活性剂后为8.92，p < 0.03）。各组之间的血流动力学无差异。病理分析表明，与S组动物的肺叶相比，所有接受PLV治疗动物的依赖肺叶以及S-PLV动物的所有肺叶的肺损伤均减轻（p < 0.05）。我们得出结论，表面活性剂疗法与PLV联合使用比单独使用表面活性剂疗法在改善氧合、呼吸系统力学和肺病理学方面的程度更大。给药顺序影响初始生理反应和最终病理结果：在PLV之前给予表面活性剂在病理结果方面产生了最大的改善。
