【作者】 付忠华；

【导师】 郭光华；

【作者基本信息】 南昌大学 ， 外科学， 2007， 硕士

【摘要】 目的观察常规机械通气(CMV)和高频振荡通气(HFOV)及其联合肺泡表面活性物质(PS)对重度蒸汽吸入性损伤并急性呼吸衰竭兔的肺组织学及细胞早期凋亡的影响。方法新西兰大白兔32只制成重度蒸汽吸入性损伤并急性呼吸衰竭模型,随机分为四组,采用四种方法进行通气治疗(CMV,CMV+PS,HFOV及HFOV+PS),分别在治疗后0.5,1.5,2.5及3.5h取动脉血行血气分析。通气治疗3.5h后处死动物,右肺中叶取标本,行病理学检查;取右肺下叶肺组织测肺细胞早期凋亡率。结果伤后各组动物PaO2均降至60mm Hg以下,与伤前比较均有显著性差异(P<0.01)。四个治疗组的PaO2在通气治疗1.5h后均明显上升,通气治疗3.5h内一直有良好的PaO2。HFOV组和HFOV+PS组的PaO2分别高于CMV组和CMV+PS组(P<0.01,P<0.05);CMV+PS组在治疗1.5 h,HFOV+PS组在治疗1.5和2.5 h,PaO2明显优于相应未加PS组(P<0.05)。四个治疗组伤后各时相点的PaCO2均无明显变化(P >0.05)。同时,四个治疗组在心率、平均动脉压方面无明显差异(P>0.05)。肺组织病理学检查发现HFOV组的损伤程度较CMV组明显减轻,HFOV+PS组损伤最轻,CMV+PS组次之,CMV组损伤最重。流式细胞早期凋亡率检测表明,HFOV+PS组肺组织早期细胞凋亡率相对其它三组动物为低,但各治疗组间的差异无统计学意义(P>0.05)。结论与其它三种通气模式相比,HFOV联合PS能提高蒸汽吸入性损伤兔的氧合水平,减轻肺损伤,减少肺组织内炎性细胞浸润及水肿液的渗出,但改善肺细胞早期凋亡的作用不明显。更多还原

【Abstract】 Objective To investigate the effects of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) and their combination with pulmonary surfactant(PS) therapies on steam inhalation injury.Methods Thirty-two New Zealand rabbits were randomly divided into four groups after acute respiratory failure models caused by severe steam inhalation injury were established.Then they were ventilated by CMV , HFOV , CMV+PS or HFOV+PS,respectively. Femoral arterial blood samples were obtained respectively at 0.5,1.5,2.5,3.5 h treatment timepoints for blood gas examination.After the expenrimetal period,the middle lobe in the right lung were excised for histological sections.Part of the lowest lobe of the excised right lung tissue was collected to test apoptotic rate.Results (A) PaO2 in the four groups all decreased below 60mmHg and PaO2 of postinjury had statistical significance comparing with pre-injury at the same group(P<0.01).(B) PaO2 in the four groups had increased since 1.5h treatment timepont,and values of PaO2 sustained continuously within 3.5 h treatment time.PaO2 in the HFOV and HFOV+PS groups were higher than the corresponding data in CMV and CMV+PS groups respectively (P<0.01,P<0.05).PaO2 in the CMV+PS group at 1.5h treatment timepoint and PaO2 in HFOV+PS group at 1.5h and 2.5h treatment timepoints showed significant advantages over the data in the corresponding non-PS groups at the same timepoints (P<0.05).The PaCO2 had no significant difference in the four groups at different treatment timepoints (P>0.05) and also there were no obvious differences in apoptotic rates(P>0.05). (C) Histological injury found the HFOV groups were more alleviated than the CMV group,the lowest in the HFOV+PS group and the highest in the CMV group.Conclusion HFOV combined with exogenous PS can improve arterial oxygenation,alleviate pulmonary edema and injury,with no obvious changes on apoptotic rate.更多还原