不同时间段大容量肺灌洗治疗犬海水淹溺肺损伤的实验.docVIP

　　不同时间段大容量肺灌洗治疗犬海水淹溺肺损伤的实验 【摘要】 目的 本研究主要探讨不同时间段大容量肺灌洗治疗犬海水淹溺肺损伤的有效性。方法 18只普通级健康杂种犬建立全肺海水淹溺肺损伤模型后随机分成A、B、C三组，A组6只，伤后单纯给予输液；B组6只，伤后15 min在纤支镜引导下分别行左右肺0.45%NaCl大容量灌洗；C组6只，伤后60 min行左右肺0.45%NaCl大容量灌洗，处理方法同B组，观察自主呼吸24 h间三组犬双肺换气功能，比较三组犬胸腔积液含量（TFC）、支气管肺泡液中乳酸脱氢酶（LDH-L）和碱性磷酸酶（ALP）的活性、两侧肺标本病理学变化程度及肺组织含水量。结果 全肺灌洗总量约30 ml/kg，纤支镜至各肺段吸引后双肺灌洗液吸出率约75%～80%。三组犬伤后PaO2均显著下降，B组、C组犬灌洗后PaO2进一步轻度下降至（4.85±0.62）kPa，30 min后逐渐回升，灌洗60 min后各相应时段对应点PaO2均远超A组犬，尤以B组显著；B组、C组肺水含量小于A组（Plt;0.05），灌洗60 min后各相应时段对应点B组、C组TFC较A组少（Plt;0.05）；B组、C组潮气量在灌洗后呈回升趋势，较A组灌洗后2 h各时段对应点明显增大（Plt;0.05）；B组、C组支气管肺泡液中LDH-L、ALP在灌洗后各时段对应点较A组显著减低（Plt;0.01）；A组犬双肺水肿，呈暗红色肝样变、肺不张和局限代偿性肺气肿，Ⅰ、Ⅱ型肺泡上皮细胞和肺毛细血管内皮细胞损伤，B组、C组两肺呈现散在暗红色肝样变，但较A组损伤程度及范围明显减小，而C组的损伤程度及范围较B组明显。结论 早期肺灌洗有效减轻犬海水淹溺所致肺组织细胞损害，减轻炎症反应，改善肺功能，而且淹溺后施行大容量肺灌洗治疗时间越早，效果越显著。 【关键词】 海水淹溺 肺损伤 肺灌洗 时间 Experimental study on different time massive bronchoalveolar lavage in the treatment of dogs ent effects of different time massive bronchoalveolar lavage on acute lung injury of near droongrel dogs ized into 3 groups.the dogs in group A aintained intravenous saline transfusion and breathed air freely for 24 h after injury.Those in group B received a massive bronchoscopic lavage l of 0.45% saline to injured lung at 15 minute after injury and those in group C received a massive bronchoscopic lavage l of 0.45% saline to injured lung at 60 minute after injury then group B and group C inistered similarly to those in group A.Gas exchange function of bilateral lungs and the levels of lactate dehydrogenase，alkaline phosphatase in bronchoalveolar fluid（BAF） in the process odynamics indices onitored continuously.By the end of the study，lungs orphological study under both light and electronic microscopes and for lung ination.Results e l/kg，the liquid volume remained in lung after operating 80 ml to 120 ml.All animals had a significant decline in pulmonary function after near droore improved in group B and group C than in group A.The inflammatory reaction and edema inlungs arkedly in group B.Conclu