目的探讨在单肺通气(OLV)下肺叶切除患者中行急性超容量血液稀释(AHHD)对血流动力学及肺血管外肺水、肺渗透性的影响。方法选取OLV下行肺叶切除患者12例行AHHD,选用6%万汶(羟乙基淀粉130/0.4氯化钠)15ml/kg在麻醉诱导后30min内输注完毕...目的探讨在单肺通气(OLV)下肺叶切除患者中行急性超容量血液稀释(AHHD)对血流动力学及肺血管外肺水、肺渗透性的影响。方法选取OLV下行肺叶切除患者12例行AHHD,选用6%万汶(羟乙基淀粉130/0.4氯化钠)15ml/kg在麻醉诱导后30min内输注完毕。术中监测中心静脉压(CVP)、血红蛋白(Hb)、血细胞比容(Hct),并动脉采血行血气分析。经股动脉放置PICCO(PV2014L13,pulson medical systems)热稀释导管,监测平均动脉压(MAP)、心指数(CI)、全心舒张末期容积指数(GEDVI)、胸腔内血容量指数(ITBVI)、血管外肺水指数(EVLWI)、肺通透性变化指数(PVPI)等参数。观察麻醉前、稀释一半、稀释结束及术毕各参数变化。记录出血、输液及输血量,观察尿量。结果稀释后CI,GEDVI,ITBVI明显增加(P<0.05),EVLWI,PVPI轻度增高(P>0.05);Hb和Hct较稀释前无显著差异;血气分析结果基本正常。结论在单肺通气下行肺叶切除患者中,采用6%万汶(羟乙基淀粉130/0.4氯化钠)15ml/kg行血液稀释既可保证血容量,又不增加心脏前负荷;对EVLWI,PVPI无明显影响。展开更多
Hyperpermeability is a crux of pathogenesis of sudden lung edema in many pulmonary disorders. especially in acute lung injury and adult respiratory distress syndrome(ARDS). Using our modified method for assessment of ...Hyperpermeability is a crux of pathogenesis of sudden lung edema in many pulmonary disorders. especially in acute lung injury and adult respiratory distress syndrome(ARDS). Using our modified method for assessment of pulmonary vascular permeability. we observed the effects of xanthine with xanthine oxidase(X-XO) perfused in rat pulmonary artery and the protection of vasoactive intestinal polypeptide(VIP) against the injury of pulmonary vascular permeabilrty. After addition of xanthine oxidase in the perfusate reservoir containing xanthine￣(125) I-albumin leak index (￣(125)IALI)was remarkably increased while peak airway pressure(Paw) was not significantly increased, and perfusion pressure of pulmonary artery(Ppa)and lung wet/dry weight ratio(W/D) were only slightly increased. Xanthine plus xanthine oxidase also increased thromboxane B_2(TX B_2) and 6-keto-prostaglandin F_(1α)(6-keto -PGF_(1α)) in the perfusate. Treatment with VIP obviously reduced or totally prevented all signs of injury. Simultaneously, VIP also diminished or abolished the associated generation of arachidonate products. The results indicated that VIP has potent protective activity against injury of pulmonary vascular permeability and may be a physiological modulator of inflammatory damage to vascular endothelium associated with toxic oxygen metacolites.展开更多
文摘目的探讨在单肺通气(OLV)下肺叶切除患者中行急性超容量血液稀释(AHHD)对血流动力学及肺血管外肺水、肺渗透性的影响。方法选取OLV下行肺叶切除患者12例行AHHD,选用6%万汶(羟乙基淀粉130/0.4氯化钠)15ml/kg在麻醉诱导后30min内输注完毕。术中监测中心静脉压(CVP)、血红蛋白(Hb)、血细胞比容(Hct),并动脉采血行血气分析。经股动脉放置PICCO(PV2014L13,pulson medical systems)热稀释导管,监测平均动脉压(MAP)、心指数(CI)、全心舒张末期容积指数(GEDVI)、胸腔内血容量指数(ITBVI)、血管外肺水指数(EVLWI)、肺通透性变化指数(PVPI)等参数。观察麻醉前、稀释一半、稀释结束及术毕各参数变化。记录出血、输液及输血量,观察尿量。结果稀释后CI,GEDVI,ITBVI明显增加(P<0.05),EVLWI,PVPI轻度增高(P>0.05);Hb和Hct较稀释前无显著差异;血气分析结果基本正常。结论在单肺通气下行肺叶切除患者中,采用6%万汶(羟乙基淀粉130/0.4氯化钠)15ml/kg行血液稀释既可保证血容量,又不增加心脏前负荷;对EVLWI,PVPI无明显影响。
文摘Hyperpermeability is a crux of pathogenesis of sudden lung edema in many pulmonary disorders. especially in acute lung injury and adult respiratory distress syndrome(ARDS). Using our modified method for assessment of pulmonary vascular permeability. we observed the effects of xanthine with xanthine oxidase(X-XO) perfused in rat pulmonary artery and the protection of vasoactive intestinal polypeptide(VIP) against the injury of pulmonary vascular permeabilrty. After addition of xanthine oxidase in the perfusate reservoir containing xanthine￣(125) I-albumin leak index (￣(125)IALI)was remarkably increased while peak airway pressure(Paw) was not significantly increased, and perfusion pressure of pulmonary artery(Ppa)and lung wet/dry weight ratio(W/D) were only slightly increased. Xanthine plus xanthine oxidase also increased thromboxane B_2(TX B_2) and 6-keto-prostaglandin F_(1α)(6-keto -PGF_(1α)) in the perfusate. Treatment with VIP obviously reduced or totally prevented all signs of injury. Simultaneously, VIP also diminished or abolished the associated generation of arachidonate products. The results indicated that VIP has potent protective activity against injury of pulmonary vascular permeability and may be a physiological modulator of inflammatory damage to vascular endothelium associated with toxic oxygen metacolites.
