机械通气联合甲基戊乙奎醚对ARDS急性期大鼠心功能、心脏局部RAS的影响

发布时间：2018-03-19 08:38

  本文选题：急性呼吸窘迫综合征　切入点：心功能　出处：《遵义医学院》2012年硕士论文　论文类型：学位论文

【摘要】：目的：观察机械通气联合甲基戊乙奎醚(penehyelidine hydrochloride, PHCD)对急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)急性期大鼠心功能、心脏局部肾素-血管紧张素系统(renin-angiotensin system, RAS)的影响,初步探讨PHCD对ARDS大鼠心功能的保护作用及其相关机制,为临床治疗提供有效的科学依据。 方法：健康雄性Sprague-Dawley大鼠90只,鼠龄12-16周,随机分为五组,每组18只：假手术NS对照组(A组)：仅进行气管切开插管和右颈总动脉穿刺置管,尾静脉注射生理盐水0.15ml/kg; ARDS未干预组(B组)：尾静脉注射油酸0.15ml/kg,建立油酸诱导的大鼠ARDS模型；ARDS机械通气治疗组(C组)：潮气量(tidal volume, VT)=6ml/kg,呼吸频率(respiratory rate, RR)=60次/分,吸入氧浓度(fraction of inspiration O2, FiO2)=50%,吸呼比(I：E)=1：2,呼气终末正压(positive end-expiratory pressure, PEEP)=3cmH2O; ARDS PHCD治疗组(D组)：腹腔内注射PHCD0.017mg/kg; ARDS机械通气+PHCD联合治疗组(E组)：呼吸机参数同C组,PHCD用法及用量同D组。各组按造模成功后时间又分为a、b、c3个亚组,每组有效检测与活杀取材的大鼠均为6只。分别记录大鼠ARDS后1小时.ARDS后2小时、ARDS后4小时心率(heart rate, HR)、右颈总动脉收缩压(systolic blood pressure, SBP)、右颈总动脉舒张压(diastolic blood pressure, DBP)、左心室最大收缩压(left ventricular systolic pressure, LVSP)、左心室舒张末期压力(left ventricular end-diastolic pressure, LVEDP)、左心室内最大上升速率(maximum rising rate of left intraventricular pressure,+LVdp/dtmax)及左心室内最大下降速率(maximum falling rate of left intraventricular pressure,-LVdp/dtmax);各组分别在对应时间点上取动脉血后处死大鼠。取左室心肌组织放射免疫法检测血管紧张素I (angiotensin I, Ang I)、血管紧张素II (angiotensin II, Ang II)含量及肾素(Renin)活性；酶联免疫吸附法(enzyme linked immunosorbent assay, ELISA)测定血清中大鼠心肌肌钙蛋白T(cardiac troponin T, cTnT)及脑钠素(brain natriuretic peptide, BNP)水平。运用PASW Statistics v18.0统计软件单因素方差分析及Pearson相关分析分析结果。 结果：同时间点与A组相比,B、C、D、E组LVSP、±LVdp/dtmax明显降低(P0.05),LVEDP明显升高(P0.05),Ang Ⅰ、Ang Ⅱ含量及Renin活性均显著增加(P0.05),血清cTnT和BNP水平明显升高(P0.05)。同时间点与B组相比,C组LVSP、±Vdp/dtmax有所升高,LVEDP有所降低,Ang Ⅰ、Ang Ⅱ含量及Renin活性均有所降低,血清cTnT和BNP水平也有所降低,但所有指标均无统计学意义(P0.05),D组LVSP、±LVdp/dtmax明显升高(P0.05),LVEDP明显降低(P0.05),血清cTnT和BNP水平均明显降低(P0.05),Ang Ⅰ、Ang Ⅱ含量及Renin活性均有降低,但无统计学意义(P0.05),E组LVSP、±LVdp/dtmax明显升高(P0.05),LVEDP明显降低(P0.05),血清cTnT和BNP水平、心肌组织Ang Ⅰ、Ang Ⅱ含量及Renin活性均明显降低(P0.05)。大鼠心肌局部Ang Ⅱ含量及Renin活性与LVSP、±Vdp/dtmax呈负相关,与LVEDP、血清cTnT及BNP含量呈正相关。 结论：ARDS可致大鼠心肌损害、心功能降低,并激活心脏局部的RAS；机械通气联合甲基戊乙奎醚可明显改善ARDS大鼠的心功能,对心肌局部RAS激活水平存在间接抑制作用。
[Abstract]:Objective: To observe the effects of mechanical ventilation combined with penehyclidine hydrochloride (penehyelidine, hydrochloride, PHCD) on acute respiratory distress syndrome (acute respiratory distress syndrome, ARDS) of heart function in acute stage of rat cardiac renin-angiotensin system (renin-angiotensin system RAS) effect, preliminary study of protective effects of PHCD on heart function of ARDS rats and its related mechanism, and provides scientific basis for clinical treatment.
Methods: 90 healthy male Sprague-Dawley rats, rats aged 12-16 weeks, were randomly divided into five groups, 18 rats in each group: sham operation NS group (group A): only tracheotomy and the right carotid artery catheterization, intravenous injection of saline 0.15ml/kg; ARDS without intervention group (group B) intravenous injection of oleic acid 0.15ml/kg, a rat model of ARDS induced by oleic acid; ARDS mechanical ventilation group (C group): tidal volume (tidal volume, VT =6ml/kg), respiratory rate (respiratory rate, RR) =60 / min, inhaled oxygen concentration (fraction of inspiration O2, FiO2 =50%), respiratory ratio (I:E =1:2), positive end expiratory pressure (positive end-expiratory pressure, PEEP =3cmH2O; ARDS PHCD) treatment group (D group): intraperitoneal injection of PHCD0.017mg/kg; mechanical ventilation in ARDS +PHCD treatment group (E group): ventilator parameters with the C group, PHCD usage and dosage with D groups. According to the successful model After the time is divided into a, B, C3 groups, each group of effective detection and killed materials are 6 rats were recorded. 2 hours after ARDS in rats 1 hours after.ARDS, 4 hours after ARDS, heart rate (heart rate, HR), the right carotid artery systolic blood pressure (systolic, blood pressure, SBP), the right carotid artery diastolic pressure (diastolic, blood pressure, DBP), left ventricular systolic pressure (left ventricular systolic max pressure, LVSP), left ventricular end diastolic pressure (left ventricular end-diastolic pressure, LVEDP), the left ventricle maximum rise rate (maximum rising rate of left intraventricular pressure, and +LVdp/dtmax) the left ventricle maximum decline rate (maximum falling rate of left intraventricular pressure, -LVdp/dtmax); arterial blood at the corresponding time point respectively after the rats were sacrificed. The left ventricular muscle were detected by radioimmunoassay. Angiotensin I (Ang Iotensin I, Ang I), angiotensin II (angiotensin II, Ang II) and the content of renin (Renin) activity; enzyme linked immunosorbent assay (enzyme linked immunosorbent assay, ELISA) were measured in serum cardiac troponin T (cardiac troponin T, cTnT) and brain natriuretic peptide (brain natriuretic peptide, BNP the level of PASW Statistics V18.0). The use of statistical software single factor variance analysis and Pearson correlation analysis results.
缁撴灉锛氬悓鏃堕棿鐐逛笌A缁勭浉姣，

本文编号：1633493