摘要
目的探讨俯卧位通气对脂多糖(LPS)诱导的肺内源性急性肺损伤(ALI)大鼠的治疗作用及其机制。方法 32只雄性SD大鼠随机分为对照组、ALI组、ALI仰卧位通气组(ALIS组)及ALI俯卧位通气组(ALIP组),每组各8只。通过气管内滴注LPS 6 mg/kg建立ALI动物模型,24 h后ALIS组及ALIP组分别实施仰卧位或俯卧位通气4 h。之后观察动脉血氧分压(PaO_2)、二氧化碳分压(PaCO_2)、肺组织湿/干重比(W/D);比较血清中肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平;光镜下观察肺组织病理形态学变化。结果与对照组比较,ALI组、ALIS组和ALIP组PaO_2明显降低(F=57.369,P<0.001),ALI组、ALIS组PaCO_2均明显升高(F=8.448,P<0.001),ALI组、ALIS组和ALIP组肺W/D及血清中TNF-α、IL-6均明显升高(F=13.609、6.443、23.849,P=0.001、0.017、<0.001);与ALI组比较,ALIS组和ALIP组PaO_2明显升高,PaCO_2、肺W/D比值、血清中TNF-α、IL-6均明显降低(P均<0.05)。与ALIS组相比,ALIP组PaO_2升高[(83±6)mm Hg vs.(71±5)mm Hg,P<0.05],PaCO_2降低[(50±7)mm Hg vs.(58±6)mm Hg,P<0.05],肺组织W/D比值降低[(4.65±0.56)vs.(4.82±0.41),P<0.05]及TNF-α、IL-6在血清中的水平均降低[(293±68)ng/L vs.(366±44)ng/L;(358±39)ng/L vs.(440±38)ng/L,P均<0.05]。同时肺组织病理形态学显示,与ALIS组相比,ALIP组腹侧过度膨胀区域减少(F=63.423,P<0.001),正常通气区域增加(F=73.229,P<0.001);ALIP组背侧塌陷区域减少(F=68.586,P<0.001),正常通气区域及过度膨胀区域增加(F=61.871,P<0.001;F=9.800,P=0.001)。结论俯卧位通气能促进LPS诱导的肺内源性ALI大鼠的气体交换,减轻肺水肿,降低炎症反应。
Objective To investigate the effects of prone ventilation in rats with lipopolysaccharide（LPS） induced pulmonary acute lung injury（ALI）. Methods Totally 32 male Sprague-Dawley rats were randomly divided into four groups, 8 rats in each group： control group,pulmonary ALI group, supine position group（ALIS） and prone position group（ALIP）. Rats in the ALI, ALIS, and ALIP groups were given 6 mg / kg LPS intratracheally to build the ALI rat model. After 24 h, rats in the ALIS and ALIP groups were were mechanically ventilated for 4 h in supine or prone positions. After that, PaO2 and PaCO2 of arterial blood, lung tissue wet / dry weight ratio（W / D）, tumour necrosis factor-alpha（TNF-α） and interleukin-6（IL-6） concentrations in serum were compared in these four groups, and lung tissue morphometric analysis was inverstigated under light microscope at the same time. Results Compared with the control group, PaO2 were significantly lower in the ALI, ALIS and ALIP groups（F = 57.369, P〈0.001）;PaCO2 in the ALI and ALIS groups were obviously higher（F = 8.448, P〈0.001）; lung tissue W /D ratio, as well as the levels of TNF-α and IL-6 in serum were significantly higher in the ALI,ALIS and ALIP groups（F = 13.609, 6.443, 23.849; P = 0.001, 0.017, 〈0.001）. Compared with the ALI group, PaO2 in the ALIS and ALIP groups was significantly higher, but lung tissue W / D ratio, TNF-α and IL-6 in serum were obviously lower in these two groups（all P〈0.05）.Compared with the ALIS group, except PaO2 was higher [（83 ± 6） mm Hg vs.（71 ± 5） mm Hg],PaCO2[（50 ± 7） mm Hg vs.（58 ± 6） mm Hg, P〈0.05], lung tissue W / D ratio [（4.65 ± 0.56） vs.（4.82 ±0.41）, P〈0.05, TNF-α and IL-6 in serum [（293 ± 68） ng / L vs.（366 ± 44） ng / L;（358 ± 39） ng / L vs.（440 ± 38） ng / L; all P〈0.05] were obviously lower in the ALIP group. Meanwhile under light microscope, compared with the ALIS group, hyper-inflated areas were less（F = 63.423, P〈0.001）,normal
出处
《中华危重症医学杂志（电子版）》
CAS
2016年第1期9-13,共5页
Chinese Journal of Critical Care Medicine:Electronic Edition
基金
江苏省六大人才高峰基金资助计划(2009059)
嘉兴市医学重点学科重症医学基金资助项目(04-Z-08)
嘉兴市医学重点学科(支撑学科)资助项目(04-Z-08)
