肺保护性通气对急性呼吸窘迫综合征家兔肺外器官炎症反应的影响  

Effects of protective ventilation on inflammatory response of extrapulmonary organs in acute respiratory distress syndrome rabbits

作　　者：燕艳丽[1] 邱海波[1] 杨毅[1] 许红阳[1] 王丽[1] 陆晓旻[1] 孙辉明[1] 

机构地区：[1]东南大学附属中大医院危重病医学科,东南大学急诊与危重病医学研究所,南京210009

出　　处：《中华急诊医学杂志》2004年第12期804-807,i001,共5页Chinese Journal of Emergency Medicine

基　　金：江苏省医学重点基金 (H2 0 0 110 2 );江苏省 13 5医学重点人才基金;江苏省社会发展基金(BS2 0 0 0 40 9;BS990 3 2 )

摘　　要：目的　研究肺保护性通气对急性呼吸窘迫综合征 (ARDS)肺外器官炎症反应的影响。方法　用生理盐水肺泡灌洗法复制ARDS家兔模型 ,分为 6组 (1)正常对照组 ;(2 )ARDS模型组 (ARDS) ;(3)小潮气量 (VT) +最佳呼气末正压 (PEEP)组 (LVBP) ;(4)常规VT+最佳PEEP组 (NVBP) ;(5 )小VT+高PEEP组 (LVHP) ;(6 )高VT+零PEEP组 (HVZP)。后 4组机械通气 4h后 ,用逆转录PCR法 (RT PCR)检测动物肝肠组织肿瘤坏死因子 (TNF)α和白介素 (IL) 10mRNA表达 ,酶联免疫吸附法 (ELISA)测定肝肠组织TNF α及IL 10浓度。结果　LVBP组肝组织TNF α和IL 10mRNA表达分别为 (42± 9)和 (2 5±10 ) ,与ARDS模型组相比较 ,差异无显著性 ,分别为 [(37± 7)和 (2 5± 4 ) ],但显著低于NVBP [分别(5 6± 7)和 (36± 8) ]、LVHP [(5 3± 10 )和 (35± 5 ) ]和HVZP组 [(70± 10 )和 (46± 5 ) ]。LVHP组TNF α和IL 10mRNA表达明显高于LVBP组 ,但明显低于HVZP组。LVBP组肝组织TNF α和IL 10浓度与ARDS组无明显差异 ,但显著低于NVBP、LVHP和HVZP组。HVZP组肝组织TNF α和IL 10浓度最高 ,不但高于LVBP组 ,也高于LVHP组。LVBP组的肠组织的TNF αmRNA表达为 (38± 11) ,与ARDS组比较无显著差异 ,但显著低于NVBP (5 1± 9)、LVHP (5 0± 11)Objective To evaluate the influence of protective ventilation on the inflammatory response of extrapulmonary organs in acute respiratory distress syndrome (ARDS) rabbits.Methods The ARDS rabbit model was established by saline alveolar lavage. The rabbits were divided into six groups: (1)normal;(2) ARDS group;(3) low-volume (V T) with best end-expiratory pressure (PEEP) (LVBP);(4)normal-volume(V T) with best PEEP (NVBP); (5) low-volume with high PEEP (LVHP)(6) high-volume zero PEEP (HVZP); Tumor necrosis factor (TNF)-α and interleukin (IL)-10 levels in liver and intestine homogenates were measured by ELISA and their mRNA expression RT-PCR.Results In the LVBP group, the TNF-α mRNA expression in liver was(42±9), which was lower than NVBP (56±7), LVHP (53+10), and HVZP group (70±10). But there was no different between LVBP and ARDS groups. TNF-α mRNA expression in LVHP group was higher than LVBP group in liver tissue, but lower than HVZP group significantly.Compared with LVBP group (25±9), the IL-10 mRNA expression increased significantly in NVBP (36±8), LVHP (35±5), and HVZP group (46 ± 5). Compared with LVBP group, the TNF-αand IL-10 concentrations in liver were increased markedly in NVBP, LVHP, and HVZP. But there was no difference between LVBP and ARDS group in TNF-α and IL-10 concentration in liver. Live TNF-α and IL-10 concentration was highest in HVZP group, which was higher than LVBP and LVHP group. In the LVBP group, the TNF-α mRNA expression in intestine was (38±11), which was lower than NVBP(51±9), LVHP (50±11), and HVZP group (64±11). But there was no different between LVBP and ARDS groups. The intestine TNF-α mRNA expression in LVHP group was higher than LVBP group, but lower than HVZP group significantly. As compared with LVBP group, the TNF-α concentration of intestine in NVBP, LVHP, and HVZP were markedly increased. But there was no difference between LVBP and ARDS group in TNF-α concentration of intestine. TNF-α concentration in intestine tissue was highest in HVZP

关 键 词：ARDS TNF-α IL-10 肠组织 mRNA表达 PEEP 肺保护性通气 浓度 器官 家兔 

分 类 号：R563.8[医药卫生—呼吸系统]