不同潮气量机械通气对ALI犬肾脏的影响  

The effect different tidal volumes mechanical ventilation on renal function of ALI dogs

作　　者：赖添顺[1] 郭振辉[1] 苏磊[2] 白涛[2] 孙杰[1] 唐柚青[2] 

机构地区：[1]广州军区广州总医院急危重病救治中心MICU [2]广州军区广州总医院急危重病救治中心ICU,广州510010

出　　处：《广东医学》2008年第4期539-541,共3页Guangdong Medical Journal

基　　金：广州市科委攻关引导项目(编号:03Z-E0261)

摘　　要：目的观察不同潮气量(Vt)机械通气(MV)对油酸所致急性肺损伤犬肾脏的影响。方法用静脉注射油酸法制备犬急性肺损伤模型,造模成功后随机分为两组,分别接受不同Vt的MV(通气时间均为6h):小Vt组(L组,Vt=6ml/kg,PEEP=10cmH2O);大Vt组(H组,Vt=20ml/kg,PEEP=10 cmH2O)。动态观察血肌酐、尿素氮变化。在MV6 h后放血处死动物,开腹取肾组织,行病理学检查及TUNEL法观察细胞凋亡情况。结果急性肺损伤犬血肌酐、尿素氮呈上升趋势,L组与H组比较差异有显著性(P<0.01);肾小管组织出现不同程度的坏死、凋亡,肾脏组织学评分、细胞凋亡率两组间比较差异有显著性(P<0.01)。结论小Vt MV在一定程度上可降低不当MV导致的肾损伤,保护肾功能,避免出现急性肾功能不全。Objective To exam the effect of different tidal volumes （Vt） mechanical ventilation （MV） on renal function of dogs with oleic acidinduced acute lung injuny（ALI）. Methods Models of oleic acid induced ALI were es- tablished in mixed -bred dogs, which were randomized into two MV groups： low Vt group （L group, Vt = 6 ml/kg body weight,PEEP = 10 cmH20） and large Vt group （ H group, Vt = 20 ml/kg body weight, PEEP = 10 cmH2O）. MV with different Vt was maintained for 6 hours. Serum creatinine（Scr） and blood urea nitrogen（BUN） were measured dynamically. Dogs were killed by exsanguinations after 6 hours of ventilation, and renal tissues were sampled. Histopathological changes were examed and cellular apoptosis were detected by TUNEL in situ apoptosis determination. Results Scr and BUN increased after modeling and MV. There was significant difference between L group and H group（P 〈0. 01 ）. Modeling and MV induced different degrees of tubular necrosis and apoptosisat. There were significant differences in histopatho- logical scores and apoptosis indexes between L and H group（ P 〈 0.01 ）. Conclusion Low Vt MV can lower renal organic and functional insult and prevent acute renal dysfunction.

关 键 词：急性肺损伤 机械通气 小潮气量 急性肾功能不全 肾小管坏死 肾小管凋亡 

分 类 号：R596.1[医药卫生—内科学] R605.973[医药卫生—临床医学]