体外肺支持策略用于急性呼吸窘迫综合征的实验研究-东南大学学报医学版

体外肺支持策略用于急性呼吸窘迫综合征的实验研究

单位：贵港市人民医院重症医学科,广西贵港 537100

分类号：R563.8;R-33

出版年·卷·期（页码）：2013·32·第二期（179-183）

摘要：

目的:评价和比较静脉-静脉体外膜肺氧合(V-V ECMO)与无泵驱动体外肺辅助(PECLA)技术在急性呼吸窘迫综合征(ARDS)动物模型中应用的效果。方法:将28只幼猪随机分为健康对照组(CON组)、常规机械通气组(MV组)、ECMO联合小潮气量通气治疗组(EC组)、pECLA联合小潮气量通气治疗组(PE组)4组,采用油酸诱导法建立ARDS模型后接受不同方案治疗,进行肺功能监测、血气分析、血流动力学和常规生化检查,对不同时间点的监测数据进行分析。结果:与CON组相比,造模后动物肺功能存在显著差异,体外支持治疗对肺功能损伤较轻,EC组血流动力学无显著变化,MV组与PE组随治疗时间的延长,平均动脉压与心排量下降;MV组最终全部死亡。结论:对于传统机械通气辅助呼吸治疗无效的ARDS,体外肺支持(ECLA)策略是安全、有效的治疗手段;若血流动力学稳定,应用PECLA进行辅助则更为简单、易行。

Objective: To evaluate and compare the effect of vein-veinous extracorporeal membrane oxygenation(V-V ECMO) and pumpless extracorporeal lung assist(PECLA) applied on animal modeled as acute respiratory distress syndrome(ARDS).Methods:28 piglets were randomly divided into four groups. ARDS model was established with olive acid followed by different treatment. Lung function, blood gas analysis,the hemodynamic,blood cell test and biochemical examination were carried out at different time points.Results:Compared with group CON, the lung function and blood gas analysis of ARDS animal exist significant differences,but group PE and group EC was better than the mechanical ventilation group;Hemodynamic of group EC was steady,but MAP and CO of group MV and group PE was descent.All of group MV was death.Conclusion:To the ARDS failure in traditional mechanical ventilation treatment,ECLA strategy is safe, effective treatment method.If hemodynamic was stable,PECLA would provide more convenience to medical procedures.

参考文献：

[1] PAULSON T E,SPEAR R M,PETERSO N,et al.New concepts in the treatment of children with acute respiratory distress syndrome[J].J Pediatr,1995,127(2):163-175.
[2] ZHU Y B,LING F,ZHANG Y B.A novel,stable and reproducible acute lung injury model induced by oleic acid in immature piglet[J].Chin Med J(Engl),2011,124(24):4149-4154.
[3] BARTLETT R H,GAZZANIGA A B,JEFFERIES M R,et al.Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy[J].Trans Am Soc Artif Intern Organs,1976,22:80-93.
[4] 龙村,赵举,李欣,等.ECMO-体外膜肺氧合[M].北京:人民卫生出版社,2010:45-49.
[5] KASAMA A,KATADA M,KAYA K,et al.A simple method of extracorporeal membrane oxygenation(ECMO)-3.The effects of pumpless ECMO (arterio-venous shunt) on arterial blood gas measured for 24 hours[J].Masui,1990,39(2):162-167.
[6] PHILLIPP A,BEHR R,RENGR M,et al.Pumpless extracorporeal lung assist[J].J Extra Corpor Technol,1998,30(1):38-41.
[7] FLOERCHINGER B,PHILIPP A,FOLTAN M,et al.Switch from venoarterial extracorporeal membrane oxygenation to arteriovenous pumpless extracorporeal lung assist[J].Ann Thorac Surg,2010,89(1):125-131.
[8] MULLER T,LUBNOW M,PHILIPP A,et al.Extracorporeal pumpless interventional lung assist in clinical practice:determinants of efficacy[J].Eur Respir J,2009,33(3):551-558.
[9] KOPP R,BENSBERG R,WARDEH M,et al.Pumpless arterio-venous extracorporeal lung assist compared with veno-venous extracorporeal membrane oxygenation during experimental lung injury[J].Br J Anaesth,2012,108(5):745-753.
[10] 叶正龙,徐巧莲,李士荣,等.机械通气对急性肺损伤大鼠炎症反应的影响[J].东南大学学报:医学版,2009,28(6):504-507.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录