不同剂量地塞米松对海水淹溺型急性肺损伤的治疗作用观察

发布时间：2018-03-30 04:09

本文选题：地塞米松　切入点：淹溺　出处：《解放军医学杂志》2009年07期

【摘要】：目的通过比较不同剂量地塞米松对海水淹溺型急性肺损伤(SWD-ALI)的治疗作用,探讨地塞米松的应用价值并选择理想的治疗剂量。方法健康成年新西兰兔28只,用随机数字表法均分为4组:S组(制作SWD-ALI模型后不做任何处理)及D0.5组、D1组、D5组(制作SWD-ALI模型后,分别经耳缘静脉注入地塞米松磷酸钠0.5、1.0、5.0mg/kg)。分别观察各组灌注前、灌注即刻(0min)及灌注后30、60、120、180min时的呼吸频率、动脉血气及部分时间点血清TNF-α水平,于实验终点测定血清总蛋白含量,并进行肺组织病理学检查,测定肺湿/干重比、肺微血管通透指数。结果海水灌注后各组动物均出现呼吸频数,D5组出现四肢阵挛;与S组比较,各地塞米松治疗组PaO2、PaCO2及BE均轻度改善,支气管肺泡灌洗液(BALF)中细胞总数及中性粒细胞比例均明显减少(P0.01),肺组织湿/干重比、肺微血管通透指数、肺组织病理评分及TNF-α表达水平均显著减低(P均0.01),除TNF-α水平下降以D5组为著外,其余各项指标改变均以D0.5组最为显著。结论地塞米松治疗可有效改善低氧血症,减轻肺水肿和肺损伤程度,降低肺微血管通透性,减轻炎症反应,并且以小剂量使用更为安全有效。
[Abstract]:Objective to compare the therapeutic effects of dexamethasone (Dexamethasone) at different doses on acute lung injury after seawater drowning (SWD-ALI), and to explore the application value of dexamethasone and to select an ideal dosage of dexamethasone. Methods 28 healthy adult New Zealand rabbits were used. They were randomly divided into 4 groups: group 1: s (no treatment after making SWD-ALI model) and group D 0.5: group D 1: group D 5 (after making SWD-ALI model). Dexamethasone sodium phosphate (0.5 mg / kg) and dexamethasone sodium phosphate (0.5 mg / kg) were injected intravenously through ear margin. The respiratory rate, arterial blood gas and serum TNF- 伪 levels were measured at the end of the experiment and lung histopathological examination, and the lung wet / dry weight ratio was measured at the end of the experiment, and the respiratory rate, arterial blood gas and serum TNF- 伪 were measured at the end of the experiment. Results the respiratory frequency and limb clonus were found in all groups after seawater perfusion, compared with group S, PaO2 and be were slightly improved in each dexamethasone treatment group. The total number of cells and the percentage of neutrophils in bronchoalveolar lavage fluid (BALF) were significantly decreased, the lung tissue wet / dry weight ratio and the pulmonary microvessel permeability index were significantly decreased. The pathological score of lung tissue and the expression of TNF- 伪 were significantly decreased (P < 0.01). Except for the decrease of TNF- 伪 level in D5 group, the changes of other indexes were most significant in D0.5 group. Conclusion Dexamethasone treatment can effectively improve hypoxemia. It can reduce the degree of pulmonary edema and lung injury, reduce the permeability of pulmonary microvessel, alleviate inflammatory reaction, and it is more safe and effective to use low dose.
【作者单位】：海军总医院呼吸内科;海军总医院干一科;海军总医院血液科;
【基金】：全军“十一五”后勤科研计划课题(06-3305)
【分类号】：R83;R96

【共引文献】