不同潮气量通气对大鼠呼吸机相关性肺损伤模型的影响  

Effect of Different Ventilatory Volumes on Ventilator-induced Lung Injury: A Study of a Rat Model of Ventilator-induced Lung Injury

作　　者：武庆平[1] 刘萍[1] 王立奎[1] 姚尚龙[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉学教研室,武汉430022

出　　处：《华中科技大学学报（医学版）》2006年第4期511-514,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.30471661);湖北省科技攻关计划资助项目(No.2005AA301C23)

摘　　要：目的通过建立过度通气导致呼吸机相关性肺损伤(VILI)大鼠模型,评估不同潮气量对肺损伤的影响。方法清洁级SD大鼠随机分成对照组(A组)、正常通气组(B组)、过度通气小潮气量[潮气量(VT)=20 ml/kg]组(C组)和过度通气大潮气量(VT=40 ml/kg)组(D组)。机械通气组中每只大鼠采用经口气管插管。观察各组通气1、2和4 h肺病理学改变、肺含水量、肺泡灌洗液(BALF)中白细胞总数(WBC)、总蛋白(Tp)、乳酸脱氢酶(LDH)含量的变化,以及两组过度通气组大鼠不同时程机械通气后3 d内的死亡率。结果与A组和B组相比,两组过度通气组大鼠的肺组织湿/干比值及肺损伤评分均明显升高,BALF中的WBC计数、LDH、Tp含量显著性增加,且D组BALF中WBC计数、LDH、Tp含量较C组更高,并随着通气时间延长而增加。两组过度通气组大鼠生存率无明显差异。结论过度通气会导致严重的VILI。潮气量40 ml/kg通气4 h更能可靠复制VILI大鼠模型。Objective To establish an experimental model of ventilator-induced lung injury （VILI） in rats through tracheal tube and evaluate the influence of different ventilatory volumes on VILI in rat lung. Methods A total of 96 specific-pathogen free Sprague-Dawley rats （250-360 g） were randomly divided into control group （group A, n= 15）, normal tidal volume （VT） group （group B, n= 15, VT=10 ml/kg）, hyperventilation group of large VT （group C, n：15, VT=20 ml/kg）, hyperventilation group of relative larger VT （group D, n=15, VT=40 ml/kg）. Rats in groups C and D were randomly divided into 3 subgroups respectively by 1, 2 and 4 h. Rats were inserted tracheal catheter via mouth under urethan injection anesthesia. Rats received different volume ventilation except the control group. The samples of lung were collected at 1, 2 and 4 b after ventilation. The arterial catheter was used for hemodynamics recording and monitoring blood gases. Lung pathological examination, lung water measure, quantity of LDH, total protein, white blood cells and TNF-α in bronchoalveolar lavage fluid were detected. Rat survival rate in groups C and D was analyzed. Results High volume mechanical ventilation resulted in substantial lung morphological changes. The interstitial pulmonary edema and pneumorrhagia were significantly severer in groups C and D than in the control group and normal tidal volume group. The quantities of LDH, total protein, white blood cells and TNF-α in BALF were also significantly increased in groups C and D. The quantities of LDH, total protein and white blood cells in BALF in group D were higher than in group C. These tendencies were basically positively correlated to time. No significant difference in survival rate was found among all groups. Conclusion High volume mechanical ventilation results in severe VILI. From these results, it can be concluded that relative larger VT （40 ml/kg） was right volume mechanical ventilation in the establishment of animal model of VILI.

关 键 词：肺损伤 通气过度 疾病模型 动物 

分 类 号：R614[医药卫生—麻醉学]