在接受机械通风的健康母猪中,非通风性肺损伤的病理生理特征
Elena Spinelli1, Anna Damia2, Francesco Damarco3
1Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Communications medicine
|February 16, 2024
概括
非通风性肺损伤 (NVLI) 在机械通风后24小时内发生. 这种损伤涉及肺部崩,炎症和 perfusion 变化,并且只有低潮水体积才能部分预防.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 病理生理学 病理生理学
背景情况:
- 传统上,非通风的肺部区域被认为是免受通风相关的肺损伤.
- 然而,初步数据表明,在这些区域存在潜在的损伤机制,如低 perfusion 和炎症.
研究的目的:
- 调查猪在单方面机械通风后24小时内出现非通风性肺损伤 (NVLI).
- 描述与NVLI相关的病理生理学变化.
主要方法:
- 对猪进行单侧机械通风,不包括左肺,有两种不同的潮体积 (15vs7.5毫升/公斤).
- 对照组接受了双边通风.
- 测量包括肺缩,输液,气道压力,炎症标志物 (IL-6,IL-1β,TNF-α,angiopoietin-2),以及组织学损伤得分.
主要成果:
- 与对照动物的正常扩展肺相比,非通风肺的组织损伤得分显著更高.
- NVLI与广泛的肺缩,低的肺 perfusion 和高的吸气气道压力有关.
- 在支气管支气管洗液中观察到炎症性细胞因子和 ангиопоэтин-2 的升高.
- 减少潮体积部分缓解了炎症和内皮激活,但没有防止肺损伤.
结论:
- 非通风性肺损伤发生在控制机械通风后的24小时内.
- 多种病理生理学变化有助于NVLI.
- 低潮水量只提供了对NVLI的部分保护.
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