机械通气诱导大鼠肺损伤病理及炎性细胞因子的变化  

The effects of mechanical ventilation-induced lung injury on concentration of proinflammatory cytokines in rats

作　　者：董春山[1] 徐志新[2] 徐瑞好[1] 陈雪鸿[3] 陈蓉[4] 姜涛[3] 苗玉清[3] 温浩[2] 

机构地区：[1]合肥市第一人民医院麻醉科,安徽合肥230061 [2]新疆医科大学第一附属医院麻醉科 [3]新疆医科大学第一附属医院动物实验中心 [4]新疆医科大学病理教研室

出　　处：《中国呼吸与危重监护杂志》2008年第2期135-139,164,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探索不同机械通气压力对肺损伤病理及炎性细胞因子巨噬细胞炎性蛋白2(MIP-2)和肿瘤坏死因子α(TNF-α)的影响。方法45只SD大鼠随机分成三组(每组15只):自主呼吸组、高容低频通气组(VT34mL/kg,RR30次/min)和低容高频通气组(VT8mL/kg,RR60次/min)。高容低频通气组和低容高频通气组通气时间120min,通气期间监测平均动脉压(MAP)、血氧饱和度(SpO2)、体温(T)和血气分析。实验完成后抽取动脉血,处死大鼠取其肺叶组织,进行支气管肺泡灌洗液(BALF)提取,观察肺组织病理和肺湿/干重比值,分析动脉血细胞数、类型和细胞聚集反应,ELISA法检测动脉血和BALF中MIP-2和TNF-α浓度。结果通气组大鼠肺组织均出现病理性改变,高容低频通气组较低容高频通气组明显;高容低频通气组大鼠肺湿/干重比值大于其他两组(P均<0.05);三组细胞数、类型和细胞聚集反应结果比较无显著差异。三组血液和BALF中MIP-2和TNF-α浓度有显著差异(P均<0.05),其中高容低频通气组动脉血和BALF中MIP-2和TNF-α浓度大于其他两组(P均<0.05),而低容高频通气组水平大于自主呼吸组(P均<0.05)。结论机械通气可诱导肺组织病理性损伤,其中大容量通气的肺组织损伤更为明显,血液和BALF中炎性细胞因子水平增高。Objective To investigate the effects of mechanical ventilation on lung pathology and concentration of proinflammatory cytokines in rats. Methods Forty-five healthy Sprague-Dawley rats were randomly divided into three groups with 15 rats each group, ie. a control group （No mechanical ventilation） ,a high tidal volume group（ Vτ34 mL/kg, RR 30 bpm） and low tidal volume group （Vτ 8 mL/kg,RR 60 bpm）. Results There were enlarged alveolar spaces, interalveolar septum collapse, swollen and spotty hemorrhages, inflammatory cell infiltration in the ventilation groups, which were more serious in the high tidal volume group. Lung wet-to-dry weight ratio of high tidal volume group was significantly higher than that of other groups （ all P 〈 0. 05 ）. The concentrations in both macrophage- inflammatory protein-2 （MIP-2） and tumor necrosis factor-α（TNF-α） of bronchoalveolar lavage fluid （BALF） and blood samples was significantly higher in two ventilation groups than the control group（ all P 〈 0. 05 ）, which were higer in the high tidal volume group than in the low tidal volume group （ P 〈 0. 05 ）. Conclusions These results indicate that mechanical ventilation can cause lung injury, which is more serious in high tidal volume ventilation. And mechanical ventilation-induced lung injury can cause proinflammatory cytokines release, with different levels in bronchoalveolar lavage fluid and blood samples.

关 键 词：机械通气 肺损伤 巨噬细胞炎性蛋白2 肿瘤坏死因子Α 

分 类 号：R459.6[医药卫生—治疗学]