Lung edema caused by high peak inspiratory pressures in dogs. Role of increased microvascular filtration pressure and permeability.
Lung edema caused by high peak inspiratory pressures in dogs. Role of increased microvascular filtration pressure and permeability.
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DOI：
10.1164/ajrccm/142.2.321
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发表时间：
1990-08
期刊：
影响因子：
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通讯作者：
James C. Parker;Lucrecia A. Hernandez;Gesina L. Longenecker;Keith J. Peevy;Walter H. Johnson
中科院分区：
文献类型：
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作者：
James C. Parker;Lucrecia A. Hernandez;Gesina L. Longenecker;Keith J. Peevy;Walter H. Johnson
在动物实验中，具有高峰气道压（Paw）的机械通气已被证明可诱导肺水肿，但经血管滤过压和微血管通透性的相对作用尚不清楚。因此，我们研究了正压通气对两组开胸犬通气30分钟的影响，峰值气道压力为21.8 +/- 2.3 cm H2O（低气道压力）或64.3 +/- 3.5 cm H2O（高气道压力）。在通气过程中，低气道压力组未观察到血流动力学变化，但在高气道压力通气过程中，平均肺动脉压（Ppa）增加了9.9 cm H2O，吸气峰Ppa增加了24.6 cm H2O，估计平均微血管压增加了12.5 cm H2O。在同一时期，高气道压力组的肺淋巴流量增加了435%，低气道压力组增加了35%，两组的终末血管外肺水/无血干重比分别为5.65 +/- 0.27和4.43 +/- 0.13 g/g。高气道压力组左心房压力（PLA）升高2小时后，肺淋巴蛋白清除率和总蛋白的最小淋巴/血浆比值显著高于低气道压力组（p <0.05），这表明微血管通透性显著增加。在Paw增加和PLA增加期间，两组肺淋巴中淋巴前列环素浓度（以稳定代谢产物6-0-PGF 1 α测量）较基线显著增加70 - 150%（p <0.05），但组间无显著差异。（250字处删节）
Mechanical ventilation with high peak airway pressures (Paw) has been shown to induce pulmonary edema in animal experiments, but the relative contributions of transvascular filtration pressure and microvascular permeability are unclear. Therefore, we examined the effects of positive-pressure ventilation on two groups of open-chest dogs ventilated for 30 min with a peak Paw of 21.8 +/- 2.3 cm H2O (Low Paw) or 64.3 +/- 3.5 cm H2O (High Paw). No hemodynamic changes were observed in the Low Paw group during ventilation, but mean pulmonary artery pressure (Ppa) increased by 9.9 cm H2O, peak inspiratory Ppa by 24.6 cm H2O, and estimated mean microvascular pressure by 12.5 cm H2O during High Paw ventilation. During the same period, lung lymph flow increased by 435% in the High Paw and 35% in the Low Paw groups, and the terminal extravascular lung water/blood-free dry weight ratios were 5.65 +/- 0.27 and 4.43 +/- 0.13 g/g, respectively, for the two groups. Lung lymph protein clearances and minimal lymph/plasma ratios of total protein were significantly higher (p less than 0.05) after 2 h of increased left atrial pressure (PLA) in the High Paw group versus the Low Paw group, which indicates a significant increase in microvascular permeability. Lymph prostacyclin concentration in pulmonary lymph, measured as the stable metabolite 6-0-PGF1 alpha, was increased significantly by 70 to 150% from baseline (p less than 0.05) in both groups during the periods of increased Paw and increased PLA, but it was not significantly different between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)