摘要
目的探讨多巴酚丁胺引起的心输出量(CO)增加对急性呼吸窘迫综合征(ARDS)血管外肺水(EVLW)的影响。方法以内毒素持续静脉注射复制绵羊ARDS模型(22只),分成对照组(9只)和实验组(13只)。实验组给予多巴酚丁胺持续静脉注射调节CO,使CO增加高于基础值(多巴酚丁胺注射前)50%以上,对照组不给予特殊处理。采用单指示剂热稀释法测定EVLW。分别于基础值(0 h)、CO增加(≥50%)1 h和2 h时测定EVLW、血流动力学、呼吸力学和肺气体交换等指标。结果CO增加前(0 h),实验组CO为(3.9±1.2)L.min-1,CO增加1 h、2 h CO显著升高至(6.5±1.6)L.min-1和(6.6±1.7)L.min-1(P<0.01);对照组CO无明显变化(P<0.05);CO增加1 h、2 h,实验组CO显著高于对照组(P<0.01)。0 h时,实验组EVLW为(15.1±4.6)ml.kg-1,CO增加1 h2、h EVLW分别为(16.3±4.9)ml.kg-1和(16.9±6.9)ml.kg-1,CO增加前后EVLW无显著性差异(P>0.05);对照组EVLW无明显变化(P>0.05);CO增加1 h、2 h,实验组EVLW与对照组EVLW相比无显著性差异(P>0.05)。CO增加1 h、2 h,实验组平均肺动脉压和肺动脉嵌顿压与对照组相比无明显差异(P>0.05)。CO增加1 h2、h,实验组氧合指数(PaO2/FiO2)较CO增加前有降低的趋势,但无统计学意义(P>0.05)。结论多巴酚丁胺引起的CO增加对ARDS绵羊EVLW无明显影响。
Objective To determine the effect of dobutamine-induced increase in cardiac output （CO） on extravascular lung water （EVLW） in sheep with acute respiratory distress syndrome （ARDS）. Methods The ARDS sheep model was induced by infusion of endotoxin intravenously, then separated into two groups： control group （n = 9） received no intervention, test group （n = 13） received continuous infusion of dobutamine intravenously to produce CO increase ≥50% of the base value （before infusing dobutamine）. EVLW was measured by single indicator thermodilution technique. EVLW, pulmonary gas exchange, hemodynamics and pulmonary mechanics were observed at baseline （0 h）, 1 and 2 hour after CO increase ≥50% of the base value. Results At 1 h and 2 h after CO increase 50% of the base value, the CO of test group [ （6.5 ± 1.6） L·min^-1 and （6.6 ± 1.7） L· min^-1 respectively] were significantly （ P 〈 0.01 ） higher than that of control group [ （4.6 ± 0.9） L· min^-1 and （5.0 ± 1.7） L· min^-1 respectively] and the base value [ （3.9 ± 1.2） L· min^-1 ]. At 1 h and 2 h, the EVLW of test group [ （ 16.3 ± 4.9） ml· kg^-1 and （ 16.9 ± 6.9） ml· kg^-1 respectively] did not significantly （ P 〉 0.05） differ from that of control group [（15.9±8.0） ml·kg^-1 and （16.0± 8.0） ml·kg^-1 respectively] and the base value [（15.1 ± 4.6） ml· kg^-1 ]. At 1 h and 2 h, there was no significant difference （ P 〉 0.05） between test group and controlgroup of mean pulmonary arterial pressure and pulmonary arterial wedge pressure. At 1 h and 2 h, there was a decreasing trend of PaO2/FiO2 in test group. Conclusion The increase of CO induced by dobutamine did not significantly raise the EVLW in sheep with ARDS.
出处
《现代医学》
2005年第5期287-291,共5页
Modern Medical Journal
基金
江苏省医学重点基金(H200102)
2001年江苏省"135"重点人才基金
镇江市社会发展科技项目(FZ2003077)
关键词
心输出量
急性呼吸窘迫综合征
血管外肺水
绵羊
cardiac output
acute respiratory distress syndrome
extravascular lung water
sheep
