Gommers D, Eijking E P, So K L, van't Veen A, Lachmann B
Department of Anaesthesiology, Erasmus University Rotterdam, The Netherlands.
Intensive Care Med. 1998 May;24(5):494-500. doi: 10.1007/s001340050602.
To assess whether bronchoalveolar lavage (BAL) with a diluted surfactant suspension prior to surfactant instillation prevents the only transient improvement in lung function as reported after surfactant instillation in severe acute respiratory distress syndrome (ARDS).
Randomized, prospective, experimental study.
Laboratory and animal facility of a large university.
Adult male Sprague-Dawley rats (280 +/- 30 g).
All animals underwent repetitive whole lung saline lavage to induce acute lung injury. Then, animals were randomly divided into seven study groups: the first group received surfactant (150 mg/ kg) within 10 min after the last lavage (early treatment), whereas in the other six groups mechanical ventilation was continued for 3 h before treatment (late treatment). Treatment consisted of: surfactant instillation at a dose of 150 mg/kg; at a dose of 250 mg/kg; BAL with saline; BAL with a diluted surfactant suspension (2.5 mg/ml); BAL with saline, immediately followed by surfactant instillation (150 mg/kg) and BAL with a diluted surfactant suspension (2.5 mg/kg), immediately followed by surfactant instillation (150 mg/kg).
Blood gases were measured for 6 h and then BAL was performed to measure the protein concentration and surface tension properties. Mean PaO2 values increased immediately after surfactant instillation to pre-lavage values but remained stable only in the group that received surfactant immediately after the lavage procedure and the group that underwent BAL with a diluted surfactant suspension prior to surfactant instillation.
BAL with a diluted surfactant suspension prior to surfactant instillation at a later time point in lung injury resulted in a stable improvement of lung function. This improvement is comparable with the results seen after surfactant instillation immediately after lung lavage.
评估在严重急性呼吸窘迫综合征（ARDS）中，在注入表面活性剂之前用稀释的表面活性剂悬浮液进行支气管肺泡灌洗（BAL）是否能防止如报道的那样在注入表面活性剂后仅出现短暂的肺功能改善。
随机、前瞻性实验研究。
一所大型大学的实验室和动物设施。
成年雄性Sprague-Dawley大鼠（280±30克）。
所有动物均接受重复的全肺盐水灌洗以诱导急性肺损伤。然后，将动物随机分为七个研究组：第一组在最后一次灌洗后10分钟内接受表面活性剂（150毫克/千克）（早期治疗），而其他六组在治疗前继续机械通气3小时（晚期治疗）。治疗包括：以150毫克/千克的剂量注入表面活性剂；以250毫克/千克的剂量注入；用盐水进行BAL；用稀释的表面活性剂悬浮液（2.5毫克/毫升）进行BAL；用盐水进行BAL，随后立即注入表面活性剂（150毫克/千克）；用稀释的表面活性剂悬浮液（2.5毫克/千克）进行BAL，随后立即注入表面活性剂（150毫克/千克）。
测量6小时的血气，然后进行BAL以测量蛋白质浓度和表面张力特性。注入表面活性剂后，平均动脉血氧分压（PaO2）值立即升至灌洗前水平，但仅在灌洗后立即接受表面活性剂的组和在注入表面活性剂之前用稀释的表面活性剂悬浮液进行BAL的组中保持稳定。
在肺损伤的较晚时间点注入表面活性剂之前，用稀释的表面活性剂悬浮液进行BAL可使肺功能得到稳定改善。这种改善与肺灌洗后立即注入表面活性剂的结果相当。
