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ARDS : early diagnosis & prevention of irreversible change by surfactant therapy

ARDS：早期诊断

基本信息

批准号：
07457353
负责人：
KOBAYASHI Tsutomu
金额：
$ 4.67万
依托单位：
Kanazawa University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
1995
资助国家：
日本
起止时间：
1995 至 1997
项目状态：
已结题

项目摘要

(1) Determination of the reversible period in adult (acute) respiratory distress syndrome (ARDS) : In experiment to administrate endotoxin, elastase, lysolecithin, and anti-surfactant protein B monoclonal antibody in rats and rabbits, the ARDS-like symptom could be reversed by surfactant replacement until 6 hours after the arterial oxygen pressure (PaO_2) started to decrease. Therefore, 6 hours after the onset of the symptom was thought to be the reversible period. Formation of hyaline membrane, however, was noted in the alveoli even at the reversible period, uggesting that some cares should be taken to prevent the organic changes as early as possible.(2) Replacement method of surfactant and development of artificial surfactant : In rats, inhalation of an aerosolized surfactant (modified natural surfactant, Surfactant CK) reversed symptoms of ARDS-like lung injury which was induced by administration of endotoxin. By this procedure, the organic change of the lung tissue, an irreversible damage, could be postponed at least for 6 hours. In addition, an artificial surfactant which was prepared with synthetic dipalmitoyl-phosphatidylcholine, phosphatidylglycerol and dioleoylphosphatidylcholine (60 : 20 : 20) plus surfactant protein B (0.7%) and C (1.4%) exhibited the same effects with Surfactant CK.(3) Relation between condition of pulmonary surfactant and vascular resistance : We found that inactivation of pulmonary surfactant induces dilatation of the capillary vessels of the alveoli. We think that this is an important finding to explain the mechanism of hypoxemia in ARDS.(4) Early diagnosis of ARDS : We have obtained some findings that surface tension values of the liquid aspirated from the trachea may by useful for early diagnosis of ARDS.

(1)成人急性呼吸窘迫综合征（ARDS）逆转期的测定：在大鼠和家兔实验中，应用内毒素、弹性蛋白酶、溶血素和抗肺表面活性物质蛋白B单克隆抗体，在动脉血氧分压（PaO_2）开始下降后6h，肺表面活性物质可逆转ARDS样症状。因此，认为症状发作后6小时为可逆期。但即使在可逆期，肺泡内仍可见透明膜形成，提示应注意尽早防止器质性改变。(2)表面活性剂的替代方法和人工表面活性剂的开发：在大鼠中，吸入雾化的表面活性剂（改性天然表面活性剂，表面活性剂CK）逆转了内毒素诱导的ARDS样肺损伤症状。通过这种方法，肺组织的器质性变化，这种不可逆的损伤，可以推迟至少6小时。另外，以合成的二棕榈酰磷脂酰胆碱、磷脂酰甘油和二油酰磷脂酰胆碱（60：20：20）为原料，添加表面活性剂蛋白B（0.7%）和C（1.4%）制成的人工表面活性剂，其效果与表面活性剂CK相当。(3)肺表面活性物质状态与血管阻力的关系：我们发现，肺表面活性物质失活引起肺泡毛细血管扩张。我们认为这是解释ARDS低氧血症发生机制的重要发现。(4)ARDS的早期诊断：我们发现，从气管吸出的液体的表面张力值可能有助于ARDS的早期诊断。