孔敏　徐淼　和秋莉　　袁孝忠　周煦燕　徐龙生　　杨茂宪

[摘要] 目的 探討俯卧位通气对海水淹溺所致急性呼吸窘迫综合征大鼠的治疗作用及其机制。 方法 32只雄性SD大鼠随机分为对照组、ARDS组、仰卧位通气组（S组）及俯卧位通气组（P组），每组各8 只。通过气管内滴注海水4 mL/kg建立ARDS动物模型。对照组、ARDS 组2 h后检测各指标;S组及P组在ARDS建模后分别进行仰卧位或俯卧位机械通气2 h后检测指标。检测动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、肺湿/干质量（W/D）比值;收集支气管肺泡灌洗液并测定上清液中蛋白水平;肺组织匀浆后检测髓过氧化物酶（MPO）及肿瘤坏死因子水平-α（TNF-α）。 结果 与对照组比较，ARDS组、S组、P组PaO2均明显降低（P<0.05）;与S相比较，P组PaO2增高（P<0.05）;与P组比较，ARDS组、S组PaCO2 均明显升高（P<0.05）;与ARDS 组比较，S组、P组肺 W/D 比值及BALF中总蛋白含量均明显降低（P均<0.05）;与P 组比较，S组肺 W/D 比值及BALF中蛋白含量均明显增高（P<0.05），ARDS组及S组肺组织MPO及TNF-α显著升高（P均<0.05）;显微镜下，与S组比较，P组塌陷肺泡占比减少，膨胀肺泡占比减少，差异均有统计学意义（P均<0.05）。 结论 俯卧位通气可改善海水淹溺急性呼吸窘迫综合征大鼠的通气功能，减轻肺部炎症反应。

[关键词] 俯卧位通气;急性呼吸窘迫综合征;大鼠;海水淹溺型

[中图分类号] R714.2          [文献标识码] A          [文章编号] 1673-9701（2021）11-0026-04

Therapeutic efficacy of prone position ventilation on rats with acute respiratory distress syndrome of seawater drowning type

KONG Min1   XU Miao1   HE Qiuli1   YUAN Xiaozhong1   ZHOU Xuyan1   XU Longsheng2   YANG Maoxian3

1.Department of Anesthesiology， Affiliated Hospital of Jiaxing University， Jiaxing   314001， China; 2.Central Laboratory， Affiliated Hospital of Jiaxing University， Jiaxing   314001， China; 3.Intensive Care Unit， Affiliated Hospital of Jiaxing University， Jiaxing   314001， China

[Abstract] Objective To investigate the therapeutic efficacy and mechanism of prone position ventilation on rats with acute respiratory distress syndrome（ARDS） of seawater drowning type. Methods A total of 32 male SD rats were randomLy divided into the control group（n=8）， the ARDS group（n=8），the supine ventilation group （the S group， n=8） and the prone ventilation group（the P group， n=8）. ARDS animal model was established by intratracheal instillation of seawater with 4 mL/kg. The indexes of the control group and the ARDS group were detected after 2 hours. The indexes of the S group and the P group were detected after 2 hours of mechanical ventilation in supine or prone position after ARDS modeling， respectively. The arterial oxygen partial pressure（PaO2）， carbon dioxide partial pressure （PaCO2）， and lung wet/dry mass （W/D） ratio were measured. Bronchoalveolar total lavage fluid （BALF） was collected and the protein level in the supernatant was determined.The levels of myeloperoxidase （MPO） and tumor necrosis factor-α （TNF-α） in lung homogenate were detected. Results Compared with the control group， PaO2 in the ARDS group， the S group and the P group decreased significantly（P<0.05）. Compared with the S group， PaO2 in the P group increased significantly（P<0.05）， and compared with the P group， PaCO2 in the ARDS group and the S group both increased significantly（P<0.05）. Compared with the ARDS group， the lung W/D ratio and protein content in BALF of the S group and the P group both decreased significantly（P<0.05）. Compared with the P group， the lung W/D ratio and protein content in BALF of the S group both increased significantly（P<0.05）， while MPO in lung tissue and TNF-α in the ARDS group and the S group increased significantly（all P<0.05）. Under microscope， compared with the S group， the proportion of collapsed alveoli and expanded alveoli in the P group decreased，all with statistically significant differences（P<0.05）. Conclusion Prone position ventilation can improve the ventilation function of rats with ARDS after seawater drowning and reduce the inflammatory reaction in lungs.

[Key words] Prone position ventilation; Acute respiratory distress syndrome; Rats; Seawater drowning type

急性呼吸窘迫综合征（Acute respiratory distress syndrome，ARDS）是由肺外源性和（或）肺内源性引起的以严重的低氧血症和（或）高碳酸血症为临床特征的呼吸衰竭[1-2]。目前尚无能够针对引起该病的病理生理机制，即肺泡毛细血管通透性增加进行治疗的方法，主要的治疗策略是机械通气治疗，它也可能引起呼吸机相关性肺损伤[3-4]。目前的观点认为俯卧位通气联合肺保护性通气策略可以作为轻度、中度ARDS的一线救治方法[5-6]。既往研究发现俯卧位通气可以降低ARDS患者病死率[7-8]，但俯臥位通气治疗因海水淹溺引起的ARDS未见报道。海水淹溺后大多数患者容易引起肺泡毛细血管膜损伤，通透性增加，继发肺水肿，并继发海水急性呼吸窘迫综合征（Seawater inhalation induced acute respiratory distress syndrome，SW-ARDS），病死率极高[9-10]。……