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Effects of lung protective ventilation on inhibiting inflammatory mediators released into plasma and bronchial alveolar lavage fluid in acute respiratory distress syndrome caused by pulmonary and extrapulmonary insults in dog
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- Author:
- No author available
- Journal Title:
- CHINESE CRITICAL CARE MEDICINE
- Issue:
- 5
- DOI:
- 10.3760/j.issn:1003-0603.2004.05.003
- Key Word:
- 呼吸窘迫综合征,急性;肺保护性通气;炎性介质;支气管肺泡灌洗液
Abstract： 目的观察在肺保护性通气条件下急性呼吸窘迫综合征(ARDS)模型犬氧合指数以及外周血和肺不同部位(肺上区、肺下区腹侧和肺下区背侧)支气管肺泡灌洗液(BALF)中炎性介质的变化.方法健康雄性杂种犬24只,随机分为肺内源性ARDS(ARDSp)实验组、ARDSp对照组、肺外源性ARDS(ARDSexp)实验组和ARDSexp对照组,每组6只.采用静脉注射油酸形成ARDSexp模型,应用十六烷磺基丁二酸钠盐气管内吸入形成ARDSp模型.实验组肺损伤后进行肺保护性通气[潮气量8 ml/kg,呼气末正压(PEEP)10 cm H2O(1 cm H2O=0.098 kPa)];对照组则继续进行大潮气量通气.动态观察肺保护性通气条件下ARDS模型犬外周血和肺不同部位(如肺尖叶、肺心叶和肺膈叶)BALF中的炎性介质,如肿瘤坏死因子α(TNFα)、白细胞介素(IL1β,IL6)的变化.结果肺损伤后ARDS模型犬氧合指数均显著恶化,外周血中炎性介质明显升高(P均<0.05),ARDSp模型犬肺尖叶和心叶BALF中炎性介质水平明显高于ARDSexp模型犬(P均<0.05).应用肺保护性通气治疗后,实验组犬氧合指数有不同程度改善,炎性介质水平有不同程度下降;但ARDSp实验组的治疗效果不如ARDSexp实验组.结论 ARDSexp和ARDSp的肺不同部位炎性介质释放和氧合指数改善均具有明显的差异,而肺保护性通气模式对ARDSexp模型犬具有良好的效果,对ARDSp模型犬疗效较差.
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