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目的观察在仰卧位和俯卧位条件下小潮气量+呼气末正压(PEEP)通气对急性呼吸窘迫综合征(ARDS)模型犬肺不同部位(肺上区肺尖叶、肺下区腹侧肺心叶和肺下区背侧肺膈叶)支气管肺泡灌洗液(BALF)中肾上腺髓质素(ADM)的作用,以评价不同体位肺保护通气方式对肺内/外源性ARDS(ARDSp/ARDSexp)的抗炎作用机制。方法健康雄性杂种犬24只,随机分为ARDSp仰卧位通气组、俯卧位通气组以及ARDSexp仰卧位通气组、俯卧位通气组,每组6只。静脉注射油酸制备ARDSexp动物模型;气管内注入十六烷磺基丁二酸钠盐制备ARDSp动物模型。动态观察不同卧位条件下小潮气量+PEEP对ARDS模型犬氧合指数和肺不同部位BALF中ADM的变化。结果肺损伤后ARDS犬氧合指数明显下降;ARDSp模型犬肺尖叶和肺心叶BALF中ADM水平明显高于ARDSexp模型;俯卧位条件下肺保护性通气对ARDS模型犬具有更好的治疗效果,氧合指数改善更为明显,ADM释放受到抑制。结论ARDSexp和ARDSp对肺不同部位ADM释放的影响具有明显差异;俯卧位+小潮气量+PEEP通气模式对ARDSexp和ARDSp均具有良好的治疗效果。
Objective To observe the effects of small tidal volume and positive end expiratory pressure (PEEP) on the different parts of the lung of acute respiratory distress syndrome (ARDS) model in supine and prone position Heart and lungs in the lower part of the lung diaphragm) bronchial alveolar lavage fluid (BALF) adrenomedullin (ADM) role to evaluate the different positions of lung protection ventilation on lung / exogenous ARDS (ARDSp / ARDSexp) anti-inflammatory mechanism of action. Methods Twenty-four healthy male dogs were randomly divided into ARDSp supine position ventilation group, prone position ventilation group and ARDSexp supine position ventilation group and prone position ventilation group, with 6 in each group. Animal model of ARDSexp was established by intravenous injection of oleic acid. ARDSp animal model was established by intratracheal injection of sodium cetyl sulfosuccinate. The changes of oxygenation index and the ADM in BALF of different parts of the lung in dogs under different supine position with different tidal volume and PEEP were observed dynamically. Results The oxygenation index of ARDS dogs decreased significantly after lung injury. The levels of ADM in lung apex and pulmonary heart of ARDSp model rats were significantly higher than that of ARDSexp model. Pulmonary protective ventilation in prone position had better therapeutic effect on ARDS model dogs , Oxygenation index improved more obvious, ADM release was inhibited. CONCLUSIONS: The effects of ARDSexp and ARDSp on the release of ADM from different parts of lung have significant differences. Prone position + small tidal volume + PEEP ventilation has good therapeutic effect on both ARDSexp and ARDSp.