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压力控制法与呼气末正压递增法肺复张对 百草枯致急性肺损伤家猪血流动力学的影响

Effects of pressure control and positive end-expiratory pressure incremental method lung recruitment ;maneuvers on haemodynamics in piglets with acute lung injury induced by paraquat

摘要:

目的:探讨压力控制(PC)法与呼气末正压(PEEP)递增法肺复张(RM)对百草枯(PQ)中毒致急性肺损伤(ALI)家猪血流动力学的影响。方法健康雌性家猪10只,经腹腔注射20%PQ溶液20mL建立PQ中毒致ALI/急性呼吸窘迫综合征(ARDS)模型,制模成功后按随机数字表法将动物分为PC法RM组(RM1组)和PEEP递增法RM组(RM2组),每组5只。于制模前(基础值)、制模成功时及RM后5、15、30min用脉搏指示连续心排血量(PiCCO)监测仪监测心率(HR)、平均动脉压(MAP)、心排血指数(CI),记录动脉血氧分压(PaO2)及动脉血二氧化碳分压(PaCO2),并计算氧合指数。于制模前、制模成功时及RM后30min取肺组织,苏木素-伊红(HE)染色后光镜下观察肺组织病理学改变。结果两组制模成功时HR、MAP、PaCO2均较基础值明显上升,CI、PaO2和氧合指数明显下降,符合ALI/ARDS表现。随RM时间延长,两组HR呈逐渐下降趋势,MAP、CI呈上升趋势;RM1组RM后5min时HR、MAP明显低于RM2组〔HR(次/min):126.8±5.2比134.0±3.8, MAP(mmHg,1mmHg=0.133kPa):98.4±3.3比102.8±2.6,均P<0.05〕,RM后5min和15min时CI明显高于RM2组(mL·s-1·m-2:56.7±5.0比46.7±6.7,65.0±5.0比56.7±5.0,均P<0.05)。RM后5min,两组PaO2和氧合指数均较制模成功时显著升高;随RM时间延长,两组PaO2和氧合指数逐渐下降,PaCO2逐渐升高,但两组各时间点间比较差异无统计学意义(均P>0.05)。RM后30min两组均出现肺泡上皮细胞脱落、肺泡间隔进一步增宽及肺泡过度膨胀,部分可见肺泡间隔断裂;RM2组较RM1组肺泡间隔明显增宽,肺泡间隔断裂也更为多见。结论 PC法与PEEP递增法RM均可明显改善PQ中毒猪ALI/ARDS时的氧合状况,且PC法RM对血流动力学的影响更小。

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abstracts:

Objective To discuss the effects of pressure control (PC) and positive end-expiratory pressure (PEEP) incremental method lung recruitment maneuver (RM) on haemodynamics in piglets with acute lung injury (ALI) induced by paraquat (PQ) poisoning. Methods The ALI/acute respiratory distress syndrome (ARDS) model was reproduced by intraperitoneal injection of 20% PQ (20 mL) in 10 healthy female piglets, and they were randomly divided into PC lung RM group (RM1 group) and PEEP incremental method lung RM group (RM2 group), with 5 piglets in each group. Heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) were monitored by pulse-indicated continuous cardiac output (PiCCO) monitoring before model reproduction (baseline), on the time of successfully set up of model and at 5, 15 and 30 minutes after RM. At the same time the arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were recorded, and oxygenation index was calculated. Lung tissues were collected before model reproduction, on the time of successfully set up of model, and at 30 minutes after RM respectively, and pulmonary pathology changes were observed after hematoxylin and eosin (HE) staining under light microscopy. Results The HR, MAP, and PaCO2 on the time of successfully set up of model in both groups were increased obviously while CI, PaO2, and oxygenation index were decreased obviously as compared with those at baseline, all of which conformed to the expression of ALI/ARDS. With RM time extended, the HR in both groups was declined while MAP and CI were increased gradually. The HR and MAP at 5 minutes after RM of RM1 group were significantly lower than those of the RM2 group [HR (bpm): 126.8±5.2 vs. 134.0±3.8, MAP (mmHg, 1 mmHg = 0.133 kPa): 98.4±3.3 vs. 102.8±2.6, both P < 0.05]. The CI at 5 minutes and 15 minutes after RM of RM1 group was significantly higher than that of the RM2 group (mL·s-1·m-2: 56.7±5.0 vs. 46.7±6.7, 65.0±5.0 vs. 56.7±5.0, both P < 0.05). PaO2 and oxygenation index at 5 minutes after RM in both groups were significantly higher than those on the time of sucessfully set up of model. The PaO2 and oxygenation index were gradually decreased, and PaCO2 was increased with RM time extended, but no statistically significant differences at all time points were found between the two groups (all P > 0.05). The lung tissue in both groups showed a variety of pathological changes at 30 minutes after RM. The main performances were the loss of alveolar epithelial cells, the further wideness of alveolar interval and the distension of alveolar, and the part breakage of alveolar interval. The wideness of alveolar interval was more significant in RM2 group than that of RM1 group, and alveolar cleft was more common too. Conclusion Both PC and PEEP incremental method lung RM can improve the oxygenation of the piglets with ALI/ARDS induced by PQ, and the PC lung RM has less impact on haemodynamics.

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