地塞米松治疗幼兔胎粪吸入综合征的实验研究

发布时间：2018-04-29 18:50

本文选题：地塞米松 + 辅助比例通气　；参考：《安徽医科大学》2012年硕士论文

【摘要】：目的观察地塞米松治疗幼兔胎粪吸入时临床参数、TNF-α、IL-8、环氧化酶水平和肺组织病理的变化。方法24只日龄20-30天的健康日本大耳幼兔随机分为3组,具体分组如下： (1)空白组(n=8)：气管插管后不灌胎粪; (2)生理盐水组(n=8)：气管插管后注入4ml/kg的45mg/ml胎粪混合物,在胎粪灌入后1h和3h静脉注射生理盐水0.5mg/kg； (3)地塞米松组(n=8)：气管插管后注入4ml/kg的45mg/ml胎粪混合物,胎粪灌入后1h和3h静脉注射地塞米松0.5mg/kg； 3组均在呼吸机比例辅助通气模式下通气,维持潮气量6-8ml/kg、血氧饱和度85%以上和呼气末二氧化碳分压(35-45mmHg)为目标调节呼吸机参数,8h后处死。分别于灌前10分钟(0点)、灌后10分钟(0’点)以及通气2h、4h、6h、8h记录各组的循环及呼吸力学参数,包括心率、呼吸频率、顺应性。在时间点0’点,2h和6h时检测动脉血气,计算氧合指数(OI)和P02/Fi02比值(P/F值)值。通气8小时后处死,左肺做湿干重比(W/D),右肺上叶苏木素-伊红(HE)染色,观察肺组织病理改变并进行肺损伤病理评分,右肺下叶做肺组织匀浆和支气管肺泡灌洗液(BALF),并用酶联免疫吸附试验测定TFN-α、1L-8、COX-1和COX-2的含量。结果： 1.通气8h各观察指标：生理盐水组和地塞米松组,RR、HR比较差异无统计学意义,P0.05；VT比较差异有统计学意义,P0.05。 2.动脉血气结果分析：通气2h动脉血血气分析结果：3组间P02、 PCO2、 PH比较差异均无统计学意义,P0.05；通气6h动脉血血气分析结果：3组间PO2、PCO2、 PH比较差异均无统计学意义,P0.05。 3.动态顺应性：3组间比较,在0时间点差异无统计学意义(F=0.073,P=0.789),其余时间点差异均有统计学意义；其中生理盐水组和地塞米松两两比较差异均有统计学意义(P0.05)。 4.氧合指数(OI)值：重复测量比较：3组间整体比较,差异有统计学意义(F=253.314,P=0.000),地塞米松组显著高于生理盐水组；时间点与组间无交互作用(P=1.000)；2h和6h间整体比较,差异有统计学意义(F=27.317,P=0.000),6h时间点显著高于2h时间点。 5.PO2/FiO2比值：重复测量的比较：3组间整体比较,差异有统计学意义(F=3097.358,P=0.000),地塞米松组显著高于生理盐水组；时间点与组间无交互作用(P=0.728)；2h和6h间整体比较,差异有统计学意义(F=16.420,P=0.000),6h较2h显著降低。 6.肺组织湿干重比(W/D)：3组间比较,差异有统计学意义(F=48.014,P=0.000),各组间比较差异有显著性意义(P=0.000),其中生理盐水组最高,空白组最低。 7.肺损伤评分：3组间比较差异有统计学意义(F=361.061,P=0.000),各组间比较差异有显著性意义(P=0.000),其中生理盐水组最高,空白组最低,病理观察生理盐水组肺组织含炎性细胞较多且弥漫性水肿较重。 8.TNF-α、IL-8含量比较：BALF和肺组织匀浆中TNF-α、IL-8含量对照组均低于地塞米松组和生理盐水组,地塞米松组低于生理盐水组[BALF中TNF-a(pg/ml):(29.2±2.0)、(47.8±3.8)、(59.2±4.4),IL-8(pg/m1)：(297.4±10.9)、(444.3±48.6)、(596.1±90.8);肺组织匀浆中TNF-a：(40.2±2.3)、(57.4±6.2)、(76.2±7.7),IL-8：(187.9±11.0)、(485.3±30.2)、(645.0±13.7)],差异有统计学意义(P均0.05)。 9.环氧化酶含量比较：3组间肺泡灌洗液和肺组织匀浆中环氧化酶1含量比较,差异均无统计学意义(均P0.05)。空白组、生理盐水组、地塞米松组3组间,肺泡灌洗液中环氧化酶2含量[(1.07±0.84)μg/L、(3.98±0.54)μ g/L、(2.58±0.43)μg/L]比较,差异均有统计学意义(均P0.05),肺组织匀浆中[(1.22±0.77)μg/L、(6.14±0.18)μg/L、(5.33±0.57)μ g/L]差异亦均有统计学意义(均P0.05)。结论： 4.1.胎粪吸入后可引起炎症因子的过度释放,引起急性肺损伤改变： 4.2.地塞米松可能通过抑制炎症因子TNF-α, IL-8,COX-2的释放,减轻胎粪吸入导致的急性肺损伤； 4.3.地塞米松能改善幼兔重度胎粪吸入时的肺部氧合状态； 4.4.地塞米松可减轻幼兔重度胎粪吸入造成的肺水肿及病理改变； 4.5.地塞米松对幼兔重度胎粪吸入时的心率和呼吸频率变化小；
[Abstract]:Objective To observe the clinical parameters , TNF - 伪 , IL - 8 , cyclooxygenase ( COX ) levels and pathological changes in lung tissues of young rabbits treated with dexamethasone .

Methods 24 healthy Japanese young rabbits aged 20 - 30 days old were randomly divided into 3 groups , the specific groups were as follows :

( 1 ) blank group ( n = 8 ) : no manure was poured after tracheal intubation ;

( 2 ) Normal saline group ( n = 8 ) : After tracheal intubation , 4 ml / kg of 45 mg / ml fetal dung mixture was injected , and the normal saline was injected at 0.5 mg / kg for 1 h and 3 h after irrigation .

( 3 ) Dexamethasone group ( n = 8 ) : After tracheal intubation , 4 ml / kg of fetal dung mixture was injected into 4 ml / kg , and dexamethasone 0.5 mg / kg was injected intravenously at 1h and 3h .

The parameters of circulatory and respiratory mechanics , including heart rate , respiratory rate and compliance , were recorded at 0 ' , 2 h , and 6 h after aeration . The lung tissues were sacrificed after 8 hours of aeration , lung tissue homogenate and lung injury pathology were observed , and the contents of TFN - 伪 , 1L - 8 , COX - 1 and COX - 2 were measured by enzyme - linked immunosorbent assay .

Results :

1 . After 8 hours of ventilation , the indexes of observation : physiological saline group and dexamethasone group , RR and HR showed no statistical significance , P0.05 ;
There was significant difference in VT compared with that of VT ( P0.05 ) .

2 . Arterial blood gas analysis : The results of arterial blood gas analysis showed that there was no significant difference between group 3 and P02 , PCO2 and PH , P0.05 ;
Results : There was no significant difference in PO2 , PCO2 and PH between three groups ( P0.05 ) .

3 . Dynamic compliance : There was no significant difference between the three groups ( F = 0.073 , P = 0.789 ) .
There were significant differences between physiological saline group and dexamethasone ( P0.05 ) .

4 . Oxygenation index ( OI ) value : The comparison between the three groups was statistically significant ( F = 253.314 , P = 0.000 ) , and the dexamethasone group was significantly higher than that in physiological saline group .
There was no interaction between the time point and the group ( P = 0.000 ) ;
The difference was statistically significant between 2h and 6h ( F = 27.317 , P = 0.000 ) , and the time point of 6h was significantly higher than 2h time point .

5 . PO2 / FiO2 ratio : The comparison between the three groups was statistically significant ( F = 3097.358 , P = 0.000 ) , and the dexamethasone group was significantly higher than that in physiological saline group .
There was no interaction between the time point and the group ( P = 0.728 ) .
The difference was statistically significant between 2 h and 6 h ( F = 16.420 , P = 0.000 ) , which was significantly lower than 2h at 6h .

6 . The wet and dry weight ratio of lung tissues ( W / D ) : 3 groups were statistically significant ( F = 48.014 , P = 0.000 ) , and there was a significant difference among the groups ( P = 0.000 ) , among which the saline group was the highest and the blank group was the lowest .

7 . There was significant difference between the three groups ( F = 361.061 , P = 0.000 ) . There was a significant difference between the groups ( P = 0.000 ) .

The levels of TNF - 伪 and IL - 8 in BALF and lung tissue homogenate were lower than those in dexamethasone group and normal saline group . The levels of TNF - a : ( 44.2 卤 2.3 ) , ( 59.4 卤 6.9 ) , ( 74.3 卤 48.6 ) , ( 56.1 卤 90.8 ) , ( 74.2 卤 7.7 ) , IL - 8 : ( 187.9 卤 11.0 ) , ( 485.3 卤 39.2 ) , ( 645.0 卤 13.7 ) were significantly higher in the lung tissue homogenate ( P < 0.05 ) .

9 . The content of cyclooxygenase - 1 in alveolar lavage fluid and lung tissue homogenate was significantly higher than that in three groups ( P0.05 ) . The difference was statistically significant ( P < 0.05 ) , and the difference of the levels of the pulmonary tissue homogenate ( 1.22 卤 0.77 ) 渭g / L , ( 6.14 卤 0.18 ) 渭g / L , ( 5.33 卤 0.57 ) 渭g / L was significant ( all P0.05 ) .

Conclusion :

4.1 . Excessive release of inflammatory factors after ingestion of fetal feces , resulting in changes in acute lung injury :

4.2 . Dexamethasone may alleviate acute lung injury caused by the release of inflammatory cytokines TNF - 伪 , IL - 8 , COX - 2 .

4 . 3 . Dexamethasone could improve the oxygenation of the lungs of young rabbits with severe fetal feces inhalation .

4.4 . Dexamethasone can reduce the pulmonary edema and pathological changes caused by heavy fetal feces inhalation in young rabbits .

4 . 5 . The rate of heart rate and respiratory rate was small in the case of severe fetal feces inhalation in young rabbits .

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.1

【参考文献】