VENTILATOR PATTERN INFLUENCES NEUTROPHIL INFLUX AND ACTIVATION IN ATELECTASIS-PRONE RABBIT LUNG
VENTILATOR PATTERN INFLUENCES NEUTROPHIL INFLUX AND ACTIVATION IN ATELECTASIS-PRONE RABBIT LUNG
复制标题
DOI：
10.1152/jappl.1994.77.3.1355
复制
发表时间：
1994-09-01
影响因子：
3.3
通讯作者：
FROESE, AB
中科院分区：
文献类型：
--
作者：
SUGIURA, M;MCCULLOCH, PR;FROESE, AB
呼吸机模式和中性粒细胞激活都会影响成人呼吸窘迫综合征 (ARDS) 的肺损伤。因此，我们质疑呼吸机模式是否独立影响早期 ARDS 中的中性粒细胞积累和功能。将 35 只新西兰白兔麻醉、麻痹，并使用无菌技术进行准备。将 15 只表面活性剂耗尽的动物随机分组，使用 15 Hz 高频振荡通气 (HFO) 通气 4 小时，激发 O-2 分数 = 1.0，动脉 PO2 (Pa-O2) > 400 Torr（一种已知可逆转肺不张的模式）或传统机械通气 (CMV)，Pa-O2 = 80-100 Torr（这种模式具有一些 尽管呼气末正压仍存在肺不张）。八只接受 CMV、Pa-O2 > 400 Torr 的正常动物作为参考组 (NorCMV)。 NorCMV 动物逐渐增加循环多形核中性粒细胞 (PMN) 数量，压力-容积曲线有轻微变化，但没有其他显着变化。灌洗 CMV 动物出现 ARDS 的特征性交换和明显的压力-容量曲线异常。循环PMN保持不变，但趋化活性降低，而肺中性粒细胞数量显着增加（P = 0.0002），并且化学发光显着增强（与NorCMV动物相比，P = 0.0003）。尽管灌洗的 HFO 动物积累了中等数量的肺中性粒细胞（肺髓过氧化物酶 > NorCMV 动物；P = 0.003），但这些 PMN 的化学发光和趋化性与来自 NorCMV 动物的细胞相同。我们得出的结论是，通过使用适当的呼吸机模式，防止表面活性剂缺乏的肺中周期性肺泡/气道扩张和塌陷，可以最大限度地减少中性粒细胞活化和肺损伤的程度。
Both ventilator pattern and neutrophil activation influence lung injury in adult respiratory distress syndrome (ARDS). We therefore questioned whether ventilator pattern independently affects neutrophil accumulation and function in early ARDS. Thirty-five New Zealand White rabbits were anesthetized, paralyzed, and prepared using sterile techniques. Fifteen surfactant-depleted animals were randomized and ventilated for 4 h using high-frequency oscillatory ventilation (HFO) at 15 Hz with an inspired O-2 fraction = 1.0 and arterial PO2 (Pa-O2) > 400 Torr (a pattern known to reverse atelectasis) or conventional mechanical ventilation (CMV) with Pa-O2 = 80-100 Torr (a pattern with some atelectasis despite positive end-expiratory pressure). Eight normal animals on CMV with Pa-O2 > 400 Torr served as a reference group (NorCMV). NorCMV animals progressively increased circulating polymorphonuclear neutrophil (PMN) numbers and had minor pressure-volume curve alterations but no other significant changes. Lavaged CMV animals developed the characteristic exchange and marked pressure-volume curve abnormalities of ARDS. Circulating PMNs remained constant but developed decreased chemotactic activity, whereas lung neutrophil numbers increased significantly (P = 0.0002) and had substantially enhanced chemiluminescence (P = 0.0003 vs. NorCMV animals). Although lavaged HFO animals accumulated an intermediate number of lung neutrophils (lung myeloperoxidase > NorCMV animals; P = 0.003), the chemiluminescence and chemotaxis of these PMNs were the same as in cells from NorCMV animals. We concluded that both the degree of neutrophil activation and lung injury can be minimized by preventing cyclic alveolar/airway expansion and collapse in the surfactant-deficient lung by use of appropriate ventilator patterns.