不同液体容量复苏对大鼠内毒素性急性肺损伤的防治作用及机制探讨

发布时间：2018-05-13 18:07

本文选题：液体复苏 + 内毒素血症　；参考：《山东医药》2015年11期

【摘要】：目的观察不同液体容量复苏对大鼠内毒素性急性肺损伤(ALI)的防治作用,并探讨其可能机制。方法将50只健康雄性SD大鼠随机分为5组各10只,A、B、C、D组制备内毒素性ALI模型,以氧合指数≤300 mm Hg时为模型制备成功;E组不制备模型。模型制备成功后开始液体容量复苏,并将此时作为零时,A组经股静脉注入高渗氯化钠羟乙基淀粉40溶液、B组注入氯化钠溶液、C组注入6%羟乙基淀粉130/0.4溶液,D组不注入任何液体,E组注入等容量生理盐水。观察注射内毒素前及注射内毒素1、3、6 h平均动脉压(MAP)变化;并于液体复苏后6 h采集大鼠股动脉血,用ELISA法检测血清TNF-α和肺表面活性蛋白D(SP-D),并行血气分析,记录Pa O2和乳酸(Lac)水平,计算氧合指数;随后处死大鼠,取肺组织,测定肺湿干重(W/D)值;HE染色观察肺组织病理学变化;按照Mikawa的方法进行肺损伤评分。结果与E组比较,A、B、C、D组W/D值、肺损伤评分及TNF-α、SP-D、Lac水平升高,MAP、Pa O2和氧合指数降低;与D组比较,A、B、C组W/D值、肺损伤评分及TNF-α、SP-D、Lac水平降低,MAP、Pa O2和氧合指数升高;与B组比较,A、C组W/D值、肺损伤评分、TNF-α、SP-D、Lac水平降低,MAP、Pa O2、氧合指数升高;与C组比较,A组Lac水平降低;P均0.05。结论高渗氯化钠羟乙基淀粉40溶液、氯化钠溶液、6%羟乙基淀粉130/0.4溶液三种液体容量复苏均能有效减轻大鼠内毒素性ALI,且高渗氯化钠羟乙基淀粉40溶液效果较其余两种更显著,其机制可能与维持肺内SP-D水平、调节SP-D抗炎作用从而减轻机体炎症反应有关。
[Abstract]:Objective to observe the preventive and therapeutic effects of different fluid volume resuscitation on acute lung injury induced by endotoxin in rats and to explore its possible mechanism. Methods 50 healthy male Sprague-Dawley rats were randomly divided into 5 groups (n = 10 each) to establish endotoxin-induced ALI model. After the successful preparation of the model, the recovery of liquid capacity began. At this time, group A was injected with hypertonic sodium chloride hydroxyethyl starch 40 solution through femoral vein at 00:00. Group B was injected with sodium chloride solution. Group C was injected with 6% hydroxyethyl starch 130 / 0.4 solution. The changes of mean arterial pressure (MAPP) before endotoxin injection and 6 h after endotoxin injection were observed, and femoral arterial blood samples were collected at 6 h after fluid resuscitation. Serum TNF- 伪 and pulmonary surfactant protein DSP-DX were detected by ELISA method, and blood gas analysis was performed. The levels of PaO2 and Lactol lactate were recorded and the oxygenation index was calculated, then the rats were killed, lung tissues were taken, lung wet and dry weight (WR / D) values were measured and the pathological changes of lung tissues were observed by HE staining, and lung injury scores were evaluated according to the method of Mikawa. Results compared with group E, W- / D, lung injury score and TNF- 伪 SP-DU Lac level in group A were higher than those in group E. Compared with group D, WPA / D value, lung injury score and TNF- 伪 SP-DLac level were decreased, WPA / D value and WR / D value in ANF- 伪 SP-DLac group were significantly lower than those in group D, and WPA / D value in ANF- 伪 group was significantly lower than that in group A (P < 0.05), and no significant difference was found between group A and group D (P < 0.05). Compared with group C, the level of TNF- 伪 SP-DU Lac decreased the level of MAPPA O _ 2 and the oxygenation index increased, and the level of Lac in group A decreased by 0.05 compared with that in group C. Conclusion three kinds of liquid volume resuscitation of hypertonic sodium chloride hydroxyethyl starch 40 solution and sodium chloride solution 6% hydroxyethyl starch 130 / 0.4 solution can effectively reduce the endotoxin induced ALI in rats, and the effect of hyperosmotic sodium chloride hydroxyethyl starch 40 solution is more significant than that of the other two solutions. The mechanism may be related to maintaining the level of SP-D in the lung and regulating the anti-inflammatory effect of SP-D.
【作者单位】：中国医科大学附属第一医院;
【基金】：国家自然科学基金资助项目(81071530)
【分类号】：R563.8

【参考文献】