Nakazawa K, Uchida T, Matsuzawa Y, Yokoyama K, Makita K, Amaha K
Department of Anesthesiology and Critical Care Medicine, Tokyo Medical and Dental University, School of Medicine, Japan.
Anesthesiology. 1998 Sep;89(3):686-92. doi: 10.1097/00000542-199809000-00019.
Partial liquid ventilation using perfluorocarbon liquids may be of therapeutic benefit in patients with acute respiratory failure. This study investigated the effects of prostaglandin E1 (PGE1) delivered intratracheally during partial liquid ventilation on lung function and pulmonary circulation in rabbits with acute respiratory distress syndrome.
Lung injury was induced by intravenous oleic acid in adult Japanese white rabbits, 1 h after which they were divided into four groups of 10 animals. Group 1 received mechanical ventilation alone, group 2 received aerosolized PGE1 (5 microg followed by 0.1 microg x kg(-1) x min(-1)) under mechanical ventilation combined with 5 cm H2O positive end-expiratory pressure, and groups 3 and 4 received partial liquid ventilation with 15 ml/kg perflubron. Group 4 received a 5-microg bolus followed by 0.1 microg x kg(-1) x min(-1) PGE1 instilled intratracheally (not by aerosol) in combination with partial liquid ventilation. Measurements were performed at 30-min intervals for 120 min after lung injury.
After lung injury, hypoxemia, hypercapnia, acidosis, and pulmonary hypertension developed in all animals and were sustained in groups 1 and 2 throughout the experiment. The partial pressure of oxygen in arterial blood of animals in group 3 improved with initiation of treatment, with statistical significance achieved at the 30 and 60 min time points as compared with controls. Group 4 animals had immediate and sustained increases in the partial pressure of oxygen in arterial blood that were significant compared with all other groups during the experiment. Statistically significant reductions in mean pulmonary artery pressure were seen only in group 4 animals compared with all other groups.
These results suggest that PGE1 delivered intratracheally during partial liquid ventilation may be a useful therapeutic strategy for patients with the acute respiratory distress syndrome.
使用全氟碳液体进行部分液体通气可能对急性呼吸衰竭患者具有治疗益处。本研究调查了在部分液体通气期间经气管内给予前列腺素E1（PGE1）对急性呼吸窘迫综合征家兔肺功能和肺循环的影响。
成年日本白兔经静脉注射油酸诱导肺损伤，1小时后将其分为4组，每组10只动物。第1组仅接受机械通气，第2组在机械通气联合5 cm H2O呼气末正压的情况下接受雾化PGE1（5微克，随后为0.1微克·千克-1·分钟-1），第3组和第4组接受15毫升/千克全氟溴烷的部分液体通气。第4组在接受部分液体通气的同时，经气管内（而非雾化）注入5微克推注剂量的PGE1，随后为0.1微克·千克-1·分钟-1。肺损伤后每隔30分钟进行一次测量，共测量120分钟。
肺损伤后，所有动物均出现低氧血症、高碳酸血症、酸中毒和肺动脉高压，第1组和第2组在整个实验过程中持续存在。第3组动物在开始治疗后动脉血氧分压有所改善，与对照组相比，在30分钟和60分钟时间点具有统计学意义。第4组动物动脉血氧分压立即且持续升高，在实验期间与所有其他组相比具有显著性。与所有其他组相比，仅在第4组动物中观察到平均肺动脉压有统计学意义的降低。
这些结果表明，在部分液体通气期间经气管内给予PGE1可能是急性呼吸窘迫综合征患者的一种有用治疗策略。
