异氟醚和异丙酚后处理对内毒素血症大鼠肺泡毛细血管屏障功能影响的差异  

The effect of posttreatment with isoflurane versus propofol on pulmonary alveolar capillary barrier in endotoxemic rats

作　　者：张鸿[1] 薛张纲[1] 蒋豪[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中华医学杂志》2005年第24期1708-1713,共6页National Medical Journal of China

摘　　要：目的比较异氟醚和异丙酚后处理对内毒素血症大鼠肺泡毛细血管屏障功能的影响。方法健康雄性SD大鼠共96只,体重250～350g。静脉注射内毒素(LPS,4mg/kg)或等量生理盐水(NS)后2h,分别给予戊巴比妥钠(C,20mg·kg-1·h-1),异氟醚(I,0.55%)或异丙酚(P,10mg/kg静脉注射,40mg·kg-1·h-1维持),分为NSC、NSI、NSP、LPSC、LPSI、LPSP共6组,每组16只。机械通气2h,每小时记录血压、血气分析,实验结束后每组8只大鼠行肺泡灌洗测定肺通透指数,测量肺组织湿干比,观察肺组织病理和电镜改变;另8只大鼠按同样方法实验,到观察时点前30min,静脉注射伊文思蓝(30mg/kg),实验结束后测定肺组织伊文思蓝含量。结果NS各组和LPS各组在各时点的平均动脉压、血气分析各指标差异均无统计学意义;各组肺组织湿干比亦未见差异;肺通透指数和肺组织伊文思蓝含量在LPSC组(8.1×10-3±2.4×10-3,吸光度0.628±0.082)比NSC组(3.3×10-3±2.2×10-3,吸光度0.479±0.154)高(P<0.05),LPSP组(9.1×10-3±2.2×10-3,吸光度0.664±0.028)比LPSI组(5.5×10-3±2.0×10-3,吸光度0.517±0.048)高(P<0.05)。肺组织光镜观察显示LPS各组比NS各组的肺部炎性损伤严重,尤其在LPSP组损伤最为严重。电镜结果提示LPSP组肺毛细血管内皮细胞间的紧密连接已裂开。结论与异丙酚相比,异氟醚保护了内毒素血症大鼠的肺泡毛细血管屏障功能,降低了肺组织通透性。Objective To compare the effects of posttreatment with isoflurane versus propofol on pulmonary alveolar capillary barrier (PACB) in endotoxemic rats.Methods Ninety-six male Sprague-Dawley rats weighing 250 to 350 g were randomly divided into 6 equal groups to be administered with intravenous lipopolysaccharide (LPS, 4 mg/kg) or equivalent volume of normal saline (NS) and treated with intravenous pentobarbital (C, 20 mg·kg -1·h -1), inhaled isoflurane (I, 0.55%) or intravenous propofol (P, 10 mg/kg bolus, 40 mg·kg -1·h -1) 2 hours after the establishment of endotoxemic model: NS-C, NS-I, NS-P, LPS-C, LPS-I, and LPS-P groups. The rats were ventilated for 2 h. The mean arterial pressure (MAP) and arterial blood gas were assessed hourly for 4 h. One cohort (n=8 per group) was subjected to bronchial alveolar lavage in the left lungs for determination of protein concentration in the bronchial alveolar lavage fluid (BALF) and the lung permeability index (LPI, BALF protein concentration/serum protein concentration). Then the right lungs were removed to undergo light and electron microscopy and measurement of the wet wet-to-dry weight ratio (WW/WD). In a second cohort (n=8 per group), Evans blue dye (EBD, 30 mg/kg) was injected 30 min before the end of the experiment to determine the EBD content in the lung. Results The MAP, pH, PaCO2, and PaO2 were not different significantly within the three NS groups and the three LPS groups and WW/WD did not show any difference among all six groups. The LPI and EBD content in lung were significantly higher in the LPS-C group [8.1×10 -3±2.4×10 -3 and 0.628±0.082 absorption unit (AU) respectively] than in NS-C group (3.3×10 -3±2.2×10 -3 and 0.479±0.154 AU respectively, both P<0.05), and were higher in the LPS-P group (9.1×10 -3±2.2×10 -3 and 0.664±0.028 AU respectively) than in the LPS-I group (5.5×10 -3±2.0×10 -3 and 0.517±0.048 AU respectively, both P<0.05). Light microscopy showed more severe lung injury changes in the LPS groups than in the NS groups, espec

关 键 词：内毒素血症 异丙酚 异氟醚 后处理 功能影响 肺毛细血管内皮细胞 静脉注射 伊文思蓝 屏障功能 血气分析 通透指数 戊巴比妥钠 肺组织病理 平均动脉压 吸光度 SD大鼠 生理盐水 机械通气 肺泡灌洗 炎性损伤 光镜观察 紧密连接 

分 类 号：R614[医药卫生—麻醉学]