摘要目的 有机磷农药中毒早期即可出现急性呼吸衰竭,能反映呼吸功能早期变化的指标不多.为此,制作重度急性敌敌畏中毒猪模型,利用PiCCO监测仪,评估敌敌畏中毒早期呼吸功能变化.方法 20只雌性家猪随机(随机数字法)分成敌敌畏组(7只)、阿托品组(7只),对照组(6只).敌敌畏组胃管注入80％乳油敌敌畏(100 mg/kg),复制重度敌敌畏中毒猪模型,阿托品组注入敌敌畏半小时后静脉推注阿托品至阿托品化并维持,对照组除不使用敌敌畏和阿托品以外,其他均相同.所有动物均在0、0.5、1、2、4、6 h 6个时点采集动、静脉血进行血气分析以及胆碱酯酶水平,记录EVLWI和PVPI值,6h后活杀动物,取肺组织行肺湿质量/干质量比及组织学观察.结果 从0.5h时点开始,敌敌畏组SaO2、PO2/FiO2出现明显下降,第1小时时点下降幅度最为明显,而PaCO2经历了先下降(1h前)而后上升的过程；阿托品组SaO2、PaCO2、PO2/FiO2先下降,但从第1小时时点开始逐渐回升.敌敌畏组EVLWI和PVPI变化过程相似,表现为逐渐升高；经过阿托品治疗后,二者上升趋势从第1小时时点开始明显减缓；对照组上述指标与基础时点比较无明显变化.相关关系分析,敌敌畏组和阿托品组,EVLWI与PO2/FiO2呈负相关关系；与PVPI变化呈正相关关系.与对照组比较,敌敌畏组肺湿质量/干质量明显增加,而阿托品组轻度增加.与此同时,敌敌畏组肺组织病理和超微病理变化显著,而阿托品组变化较轻.结论 重度急性敌敌畏中毒猪呼吸功能变化显著,EVLWI是早期评估中毒猪呼吸功能变化的有效指标.

abstractsObjective In order to extrapolate the respiratory dysfunction of patients in early stage of acute organophosphorus pesticide poisoning (AOPP),transpulmonary thermodilution technique was used in swine models of severe acute dichlorvos poisoning (SADP) to evaluate respiratory function.Methods Twenty healthy female swine were randomly divided into dichlorvos ( n =7 ),atropine ( n =7 ) and control (n =6) groups.In the dichlorvos group,the swine were administered with 80％ emulsified dichlorvos (100mg/kg) via the gastric tube toinduce SADP.In the atropine group,swinewere administered with dichlorvos,and 0.5h later,atropine was injected to obtain and maintain atropinization.The swine of control group were administered with saline solution instead.Arterial and venous blood samples were collected 0,0.5,1,2,4 and 6 hours after modeling for blood gas analysis and detecting acetylcholinesterase levels.Both extravascular lung water index (EVLWI) and pulmonary vascular permeability index ( PVPI ) were measured by using PiCCO (pulse indicator continuous cardiac output ). At the termination of the experiment,the animals were sacrificed and the lung wet/dry weight ratio was determined and histopathological changes of lung tissue were also observed under microscope.Results In the dichlorvos group,EVLWI and PVPI were substantially increased from 0.5 h to 6 h after modeling but PaO2/FiO2 decreased from 0-6 h after modeling.In the atropine group,EVLWI and PVPI increased initially,but then they decreased 1 h afterwards and PaO2/FiO2 was also gradually decreased from 0-1 h.In both dichlorvos group and atropine group,the EVLWI was negatively correlated with PO2/FiO2 and positively correlated with PVPI.Compared with the control group,the lung wet/dry weight ratio increased markedly in the dichlorvos group and mildly increased in the atropine group.Meanwhile,the histopathological changes of lung tissue were obvious in the dichlorvos group and mild in the atropine group.Conclusions SADP swine experienced substantial changes in respiratory function. EVLWI was a reliable and valuable indicator for evaluating respiratory function in the early stage of AOPP.