Effects of extracorporeal membrane oxygenation (ECMO) on lung physiology and pathology in healthy and acute respiratory distress syndrome (ARDS) piglets
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF EMERGENCY MEDICINE
- Issue:
- 7
- DOI:
- 10.3760/j.issn:1671-0282.2007.07.003
- Key Word:
- 体外膜肺;急性呼吸窘迫综合征;炎症
Abstract： 目的 研究体外膜肺(ECMO)对健康及油酸致急性呼吸窘迫综合征幼猪呼吸力学、氧合、肺部炎症反应及病理形态的影响.方法 21只健康幼猪随机分为4组:CON组(n=5);ECMO组(n=6):机械通气+ECMO 24h后观察6 h;ARDS组(n=5);AEC组(n=5):成模后以机械通气+ECMO 24 h,观察6 h.在基础状态(Base)、成模时(0 h)、以后每小时监测血气、血流动力学和呼吸力学,检测肺湿干重比(W/D),肺泡灌洗液(BALF)中总蛋白(TP)、总磷脂(TPL)、饱和磷脂(DSPC)、最小表面张力(γmin),肺组织TNF-α、IL-1β、IL-6、IL-8、IL-10 mRNA表达,及肺病理学改变.计数资料比较用方差分析,等级资料多组间差别用Ktudksl-Wallis检验.P＜0.05视为差异具有统计学意义.结果 (1)CON组和ECMO组全部存活,AEC组1只死亡,ARDS组全部于成模后24 h内死亡.(2)ARDS组和AEC组成模后OI和Aa-DO2显著升高[OI:(7.5±1.0) vs (10.5±3.8);AaDO2:(556.0±24.3) vs (558.0±18.3)],随后ARDS组OI和Aa-DO2进一步增高,而AEC组在ECMO启动后两者下降[8 h OI:(18.2±3.6) vs (7.6±9.3);Aa-DO2:(574.0±12.8) vs (329.0±279.0)].(3)与CON组比较,ARDS组和AEC组TPL下降,γmin升高,差异具有统计学意义(P＜0.01).与CON组和ECMO组比较,ARDS组IL-6和IL-8 mRNA表达显著增高(P＜0.05).(4)ECMO组有轻度肺病理损伤.与ARDS组相比,AEC组各种病变均减轻,肺泡扩张度改善.结论 ECMO转流24 h能改善ARDS幼猪氧合和气体交换,减轻肺部病理损伤,提高生存率;激活健康幼猪肺部炎症反应,引起轻度肺病理损伤.
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