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目的 探讨肺表面活性物质 (PS)异常在呼吸机所致肺损伤 (VILI)发生中的作用。方法 40只成年SD大鼠随机分成 5组 ,每组 8只 ,对照组于手术完毕后处死 ,其余 4组给予机械通气(MV) :(1)P7组 ,设置吸气峰压 (cmH2 O) 频率 (次 min) 吸呼比 呼气末正压 (PEEP) (cmH2 O)为 7 40 1∶1 0 ;(2 )P45组 ,45 2 0 1∶1 0 ;(3)PS组 ,经气道滴入PS 10 0mg kg,45 2 0 1∶1 0 ;(4 )PEEP组 ,45 2 0 1:1 10 ,2 0min后处死。观察动脉血氧 (PaO2 )、最大胸肺顺应性 (Cmax)、支气管肺泡灌洗液 (BALF)的总蛋白 (TP)、总磷脂 (TPL)、大小聚集体 (LA、SA)和最小表面张力 (STmin)。结果 与P7组比较 ,P45组PaO2 和Cmax均明显降低 (P均 <0 0 1) ,BALF的TP、SA LA和STmin显著增加 ,TPL TP降低 (P均 <0 0 1)。PS组和PEEP组各指标均显著优于P45组 (P <0 0 5或P <0 0 1)。P7组和对照组间各指标均相近。结论 VILI时有明显的PS异常 ;外源性PS和PEEP均可恢复和维持PS结构和功能 ,减轻VILI,表明PS异常与VILI的发生密切相关
Objective To investigate the role of abnormal pulmonary surfactant (PS) in the pathogenesis of ventilator-induced lung injury (VILI). Methods 40 adult Sprague-Dawley rats were randomly divided into 5 groups with 8 rats in each group. The control group was sacrificed at the end of surgery and the other 4 groups were given mechanical ventilation (MV): (1) P7 group, the peak inspiratory pressure (cmH2O) The frequency (min) of the breath-to-breath expiratory pressure (PEEP) (cmH2O) was 7 40 1:1 0; (2) P45 group, 45 2 0 1:1 0; (3) PS group, Drops of PS 10 0mg kg, 45 2 0 1: 1 0; (4) PEEP group, 45 2 0 1: 1 10, 20min after sacrifice. PaO2, Cmax, total protein (TP), total phospholipid (TPL), small and large aggregates (LA, SA) and minimum surface tension of bronchoalveolar lavage fluid (BALF) (STmin). Results Compared with P7 group, the PaO2 and Cmax in P45 group were significantly decreased (all P <0 01). The levels of TP, SA LA and STmin in BALF were significantly increased and TPL TP was decreased (all P <0.01). The indexes of PS group and PEEP group were significantly better than those of P45 group (P <0.05 or P <0.01). P7 group and control group of the indicators are similar. Conclusions There are obvious abnormalities of PS in VILI. Both exogenous PS and PEEP can restore and maintain the structure and function of PS and reduce the VILI, which indicates that PS abnormality is closely related to the occurrence of VILI