不同潮气量机械通气对复苏犬肺泡表面活性物质影响.docVIP

不同潮气量机械通气对复苏犬肺泡表面活性物质影响 　　【摘要】目的 观察不同潮气量（Vt）机械通气对室颤犬复苏后肺泡表面活性物质的影响，探讨心肺复苏的机械通气策略。方法 选用健康成年犬24只，体质量（15±2）kg，雌雄不拘，随机（随机数字法）分为3组：对照组（A组）、低Vt组（B组）和高Vt组（C组）。对照组仅进行麻醉和气管插管；其余2组经右心室导管诱发室颤制作心搏骤停模型，复苏时分别以不同潮气量（低Vt组：6 ml/kg；高Vt组：20 ml/kg）机械通气6 h，观察开始复苏前及机械通气后不同时间点犬动脉血气的变化；比较各组犬复苏成功率及72 h存活情况；采用高效液相色谱法（HPLC）检测肺泡灌洗液中磷脂酰胆碱含量；测定肺组织湿干质量比（W/D）及肺组织病理学改变评分。 结果 （1）复苏开始时B、C两组犬pH显著降低，PaO2下降，PaCO2上升，与基础值比较差异具有统计学意义（P2均升高；C组ROSC 2 h后，PaCO2较B组下降差异具有统计学意义（P3-差异具有统计学意义（P 　　【关键词】心肺复苏；机械通气；潮气量；肺损伤；肺泡表面活性物质 　　Effect of mechanical ventilation with different tidal volumes on pulmonary surfactant in dogs during cardiopulmonary resuscitation LIU Yong，HUANG Liang， YANG Ji-bin，LIU Jian. Department of Emergency Medicine，The First Affiliated Hospital of Nanchang University，Nanchang 330006，China 　　Corresponding author： HUANG Liang， Email： huangliang6312@ 　　【Abstract】Objective To observe the effects of mechanical ventilation with different tidal volumes （Vt） on the pulmonary surfactant in dogs during cardiopulmonary resuscitation（CPR） and discuss the strategy of mechanical ventilation for CPR.Methods A total of 24 healthy， adult and mongrel canines were randomly（random number） divided into three groups， namely control group（A）， low Vt group（B） and high Vt group（C）. Canines without ventricular fibrillation in group A were not supported with mechanical ventilation，while canines in group B and group C were induced to get ventricular fibrillation（VF） with pacing catheter inserted through right external carotid vein into the right ventricle. CPR was initiated with mechanical ventilation with different Vt for 6 hours after ventricular fibrillation. The Vt set in group B was 6 ml/kg body weight and Vt set in group C was 20 ml/kg body weight. The arterial blood gas analyses were tested in different intervals. The levels of phosphatidylchline in bronchia alveolus lavage fluid （BALF） was assayed with high performance liquid chromatography（HPLC）. The ratio of wet and dry weight and the morphological change sco