反比通气和PEEP对肺损伤TNF-α,IL-8,ET-1的影响  

Effects of inverse ratio ventilation and positive end-expiratory pressure on TNF-α, IL-8 and ET-1 in oleic acid- induced lung injury

作　　者：秦鑫[1] 刘又宁[1] 陈良安[1] 陈天狮[1] 

机构地区：[1]解放军总医院呼吸科

出　　处：《第四军医大学学报》2006年第14期1267-1269,共3页Journal of the Fourth Military Medical University

摘　　要：目的:探讨反比通气(IRV)和呼气末正压通气(PEEP)对油酸所致急性肺损伤肺泡灌洗液及外周血中TNFα,IL8,ET1的影响.方法:将16只新西兰大白兔随机分为两组,每组8只.IRV组,呼吸频率30次/min,I∶E=3∶1,潮气量12mL/kg,PEEP=0;PEEP组,呼吸频率40次/min,I∶E=1∶2,潮气量10mL/kg,PEEP=20cmH2O(1cmH2O=0.098kPa).两组均以容量控制通气.吸氧浓度(FiO2)=0.5.在0,30,60,90及120min由右颈外静脉导管采集混合静脉血各3mL,放免法测定血浆及肺泡灌洗液中肿瘤坏死因子(TNFα)、白细胞介素8(IL8)、内皮素1(ET1)的含量.实验结束后放血处死动物,右肺用于肺湿质量/干质量比率测定.结果:两组BALF中TNFα,IL8,ET1浓度,IRV组明显高于PEEP组(P均<0.05);两组血清中TNFα,IL8,ET1浓度,在肺损伤后30min均显著升高,明显高于肺损伤前(P<0.05).各组随着时间延长,三种细胞因子逐渐增加.PEEP组三种细胞因子浓度均明显低于对应时间点的IRV组(P均<0.05);PEEP组肺干质量占肺湿质量(62±1)%,显著低于IRV组的(79±1)%(P<0.01).BALF中三种因子含量也与肺水质量分数呈显著正相关(r1=0.8972,r2=0.9518,r3=0.8978).结论:PEEP比IRV能更好地减少急性肺损伤的肺部炎症反应.AIM： To investigate the effects of inverse ratio ventilation （ IRV ） and positive end-expiratory pressure （PEEP） on TNF-α, IL-8 and ET-1 in oleic acid-induced lung injury. METHODS： Sixteen New Zealand rabbits were randomly divided into2 groups, IRV group（n=8） and PEEP group （n=8）. The IRV group were ventilated with a tidal volume（VT） of 12 mL/kg, respiratory rate of 30 breaths/min, I： E =3 ： 1 and PEEP of 0 cmH2O; in PEEP group, VT was 10 mL/kg and respiratory rate 40 breatha/min, I：E = 1：2 and PEEP=20 cmH2O; FiO2 =0.5 in both groups. Mixed venous blood 3 mL was taken via right ereerhal jugular vein respectively at 0, 30, 60, 90 and 120min during ventilating. The animals were sacrificed by draining artery blood at the end of experiment. Right lung was cut off for wet/dry weighing and left was lavaged. Concentrations of TNF-α, IL-8 and ET-1 in blood plasma and bronchoalveolar lavage fluid （BALF） were measured by radioimmune assay. RESULTS： Levels of TNF-α,IL-8 and ET-1 in BALF in IRV group were higher than those in PEEP group （ P 〈 0.05 ）. Serum levels of TNF-α, IL-8 and ET-1 in both groups after 30 min ventilation were significantly higher than those at base points （ P 〈 0.05 ）. Additionally, with the proceeding of ventilation, TNF-α, ET-1 and IL-8 in both groups were increasing gradually （ P 〈 0.05 ）. Levels of TNF-α, IL-8 and ET-1 in serum in PEEP group were lower significantly than those in IRV group （ P 〈 0.05 ） at the similar time points. In IRV vs PEEP, the ratio of wet to dry lung （%） surging（79±1 vs 62±1, P 〈 0. 01 ）. Levels of TNF-α, IL-8 and ET-1 in BALF were correlated with the ratio of wet to dry lung（ r1= 0. 8972, r2=0.9518, r3= 0. 8978）. CONCLUSION： Lung inflammatory response of acute lung injury may be alleviated more effectively in the setting of PEEP than IRV.

关 键 词：急性病 肺/损伤 反比通气 正压呼吸 肿瘤坏死因子-α 白细胞介素-8 内皮缩血管肽1 

分 类 号：R655.3[医药卫生—外科学]