摘要
目的观察在治疗海水淹溺所致急性肺损伤时不同潮气量通气对肺炎症的抑制作用。方法新西兰兔35只,气管内缓慢灌入2ml/kg海水制备海水淹溺致急性肺损伤(SWD-ALI)动物模型。然后随机分为5组(n=7):WD-ALI动物模型组(对照组)及6、8、10、12ml/kg潮气量机械通气组(吸呼比1∶2,吸入氧浓度40%,呼气末正压为0,连续通气3h)。实验后测定血清及肺泡灌洗液肿瘤坏死因子α(TNF-α)、白介素6(IL-6)水平,并进行肺组织学检查,以评价治疗效果。结果6ml/kg潮气量机械通气治疗后肺泡灌洗液TNF-α(1.58±0.56pg/ml)与对照组(1.73±0.81pg/ml)相比明显降低(P<0.05),余各组机械通气治疗后血清及肺泡灌洗液TNF-α、IL-6水平与对照组比较无明显差异(P>0.05)。机械通气后,与对照组相比,各组肺干湿重比均明显增加(P<0.05),炎细胞浸润均明显好转(P<0.05)。6～8ml/kg潮气量机械通气治疗后肺泡隔断裂无增加,但肺泡萎陷、局灶性肺不张、肺水肿亦无明显好转(P>0.05)。12ml/kg潮气量机械通气治疗后肺泡隔断裂明显增加(P<0.05),肺泡萎陷、局灶性肺不张、肺水肿无明显改变(P>0.05)。结论小潮气量通气策略治疗SWD-ALI能够在一定程度上抑制肺内炎症反应,避免继发肺损伤。
Objective To investigate the effect of ventilation with various tidal volumes on inflammatory responses of rabbits with acute lung injury induced by seawater drowning （SWD-ALI）. Methods Animal models of SWD-ALI were established by instillation of seawater （2ml/kg BM） into the lower trachea of anesthetized rabbits （n=35）. These rabbits were then randomly assigned into control group （SWD-ALI model without ventilation, n=7） and b1, b2, b3 and b4 groups （7 each） with aminals receiving protective lung ventilation strategy with tidal volumes of 6, 8, 10 and 12ml/kg, respectively, for 3 hours. Tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） levels in serum and bronchial lavage fluid were measured after experiments. The rabbits in each group were then sacrificed to obtain lung tissues for pathological examination. Results After ventilation, no significant difference in TNF-α and IL-6 levels was found between serum and alveolar lavage fluid in the b1, b2, b3 and b4 groups and the control group （P〉0. 05）. After ventilation with 6ml/kg tidal volumes, the TNF-α in alveolar lavage fluid （1. 58±0. 56pg/ml） was significantly lower in b1 group compared with that in control group （1. 73±0. 81pg/ml, P〈0. 05）. The lung dry/wet ratio increased in all the ventilation groups than in control group （P〈0. 05）. Histological study showed that infiltrated inflammatory cells were reduced significantly in experimental groups after ventilation. There was no increase in alveolar septurn breakage, but there was no improvement in atelectasis, focal lung collapse and pulmonary edema. In b4 group, there was marked increase in broken alveolar septum, while the extent of atelectasis and edema were about the same. Conclusions Ventilation with lower tidal volumes can relieve the inflammatory responses of rabbits with SWD-ALI to some extent, and promote the absorption of lung edema fluid in the lung tissues.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2009年第7期830-832,共3页
Medical Journal of Chinese People's Liberation Army
基金
全军"十一五"后勤科研计划课题(06-3305)
关键词
急性肺损伤
海水
淹溺
接近
炎症
acute lung injury
seawater
near drowning
inflammation
