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目的 :在肺灌洗诱导的急性肺损伤 (ALI)家猪实施以氟碳 (PFC)为媒介的部分液体通气 (PLV) ,观察其对肺气体交换及血液动力学的影响 ,并比较PLV及气体通气两种方式对肺形态学的影响 ,以探讨PLV改善肺气体交换的机制。方法 :12头体重为 2 5 - 30kg的健康雌猪 ,麻醉后经肺灌洗建立ALI模型。随机分为PLV组及CV(气体通气组 )。对照组以呼吸机行常规机械通气 ,PLV组动物经气管导管肺内灌以 15mL/kg的PFC ,然后以与对照组同样的呼吸参数行机械通气。每小时记录肺气体交换及血液动力学参数的变化。于实验结束后处死动物 ,取肺标本送病理分析。结果 :PLV组肺气体交换明显改善 ,而血液动力学在整个实验过程中基本维持稳定。组织学检查 :光学显微镜下可见两组均为肺不张、肺气肿及肺过度膨胀交替出现 ,肺泡间质因水肿及细胞渗出而扩展。PLV组与CV组比较显示较轻微的肺不张、肺内炎性细胞渗出、肺出血及肺间质扩张。PLV组动物腹侧肺组织学损伤改变明显较背侧轻微。结论 :在肺灌洗诱导的急性肺损伤幼猪 ,以氟碳为媒介的部分液体通气可明显地改善肺气体交换 ,并无明显的血液动力学损伤。同时可见PLV相对于对照组明显减轻的肺组织学损伤及肺泡扩张 ,证实PLV具一定的肺保护作用。
PURPOSE: To investigate the effects of PLV on lung gas exchange and hemodynamics in lung lavage-induced acute lung injury (ALI) domestic pigs by comparing with PLV and Gas ventilation on lung morphology in two ways to explore the mechanism of PLV to improve lung gas exchange. Methods: Twelve healthy female pigs with a body weight of 25-30 kg were anesthetized and perfused with ALI model. Randomly divided into PLV group and CV (gas ventilation group). The control group was ventilated by conventional mechanical ventilation. PLV animals were infused with 15 mL / kg PFC via the endotracheal tube and then mechanically ventilated with the same breathing parameters as the control group. Changes in lung gas exchange and hemodynamic parameters were recorded hourly. Animals were sacrificed at the end of the experiment and lung samples were taken for pathological analysis. Results: The exchange of lung gas in PLV group was significantly improved, while hemodynamics remained stable throughout the experiment. Histological examination: optical microscopy showed that both groups were atelectasis, emphysema and excessive lung expansion alternately, interstitial alveolar edema and cell exudation and expansion. Compared with the CV group, PLV group showed mild atelectasis, pulmonary inflammatory cell exudation, pulmonary hemorrhage and pulmonary interstitial expansion. The ventral lung injury in PLV group was significantly less than that in the dorsal side. CONCLUSION: Partial liquid ventilation mediated by fluorocarbon can significantly improve lung gas exchange in piglets with acute lung injury induced by pulmonary lavage without obvious hemodynamic damage. PLV at the same time significantly reduced compared with the control group lung histological damage and alveolar dilatation confirmed PLV with lung protection.