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目的探讨经肺热稀释技术对不同原因急性肺损伤(ALI)血管外肺水(EVLW)测定的准确性。方法18只杂种犬随机分为正常组、外源性急性肺损伤组和内源性急性肺损伤组,每组6只,通过静脉注射油酸制备外源性ALl模型,气管内注入十六烷磺基丁二酸钠盐制备内源性ALI模型,然后分别向肺内灌注一定量的生理盐水,采用经肺热稀释法在灌注的前后测定EVLW,观察灌注前后EVLW变化与所灌注生理盐水量之间相关性。结果正常肺组织EVLW含量为(254.5±13.0)ml,肺泡灌注前后EVLW的变化与实际肺泡灌注生理盐水量之间具有良好的相关性(r= 0.986,P<0.01);外源性ALI组EVLW含量为(483.3±11.5)ml,与正常组比较差异有统计学意义(P<0.01),ALI组肺泡灌注前后EVLW的变化与实际肺泡灌注生理盐水量之间也具有良好的相关性(r=0.978,P<0.01)。内源性ALI组EVLW含量为(526.2±12.9)ml,与正常组比较差异有统计学意义(P<0.01)。肺内源性ALI组肺泡灌注前后EVLW的变化与实际肺泡灌注生理盐水量之间具有较好的相关性(r=0.890,P<0.01),但不如外源性ALI组相关性高。结论经肺热稀释技术对EVLW的监测具有良好的准确性,但不同原因导致的EVLW增加的监测准确性不同。
Objective To investigate the accuracy of pulmonary thermodilution in the determination of extravascular lung water (EVLW) in acute lung injury (ALI) of different causes. Methods Eighteen hybrids were randomly divided into normal group, exogenous acute lung injury group and endogenous acute lung injury group, with 6 rats in each group. Exogenous ALI model was established by intravenous injection of oleic acid. Cetane Sulfosuccinate sodium salt to prepare endogenous ALI model, and then to the lungs were perfusion of a certain amount of saline, the use of pulmonary thermodilution method in the determination of EVLW perfusion before and after the change of EVLW observed perfusion of saline The correlation between. Results The level of EVLW in normal lung tissue was (254.5 ± 13.0) ml. The change of EVLW before and after alveolar perfusion had a good correlation with the actual volume of saline (r = 0.986, P <0.01) (483.3 ± 11.5) ml, which was significantly different from that of the normal group (P <0.01). There was also a good correlation between the change of EVLW and the actual volume of saline before and after alveolar perfusion (r = 0.978, P <0.01). The level of EVLW in the endogenous ALI group was (526.2 ± 12.9) ml, which was significantly different from the normal group (P <0.01). There was a good correlation between the change of EVLW before and after alveolar perfusion in ALI group and the actual saline volume (r = 0.890, P <0.01), but not as high as in ALI group. Conclusions Hyperthermic Dilution technique has good accuracy for the monitoring of EVLW, but the monitoring accuracy of EVLW increase due to different causes is different.