高频振荡部分液体通气对吸入性损伤兔肺中性粒细胞凋亡影响的研究  

Effect of high frequency oscillatory ventilation and its combination with partial liquid ventilation on the apoptosis of polymorphonuclear cell in rabbit lung with acute respiratory failure induced by steam inhalation injury

作　　者：曾林祥[1] 郭光华[2] 宋凌菁[1] 

机构地区：[1]南昌大学第二附属医院呼吸内科,江西南昌330006 [2]南昌大学第一附属医院烧伤外科,江西南昌330006

出　　处：《中国现代医学杂志》2009年第8期1159-1164,共6页China Journal of Modern Medicine

摘　　要：目的观察高频振荡联合部分液体通气对蒸气吸入性损伤兔肺组织中性粒细胞早期凋亡的影响。方法新西兰大白兔40只制成重度蒸气吸入性损伤并急性呼吸衰竭模型,随机分为5组,其中1组作为对照组,致伤后给予吸氧治疗,4h后经颈动脉抽血处死,另4组分别采用4种方法进行通气治疗(CMV、CMV+PLV、HFOV及HFOV+PLV)。通气治疗4h后经颈动脉抽血处死大白兔。各组大白兔处死后立即经气管插管用生理盐水8mL×3次灌洗,并收集灌洗液。计量后离心,收集沉淀的细胞进行涂片、固定和染色,然后进行细胞计数及分类,分离细胞后使用流式细胞仪检测中性粒细胞凋亡及坏死。上清液则进行总蛋白和丙二醛检测。结果①细胞计数及分类:各组BALF回收率无明显差异,CMV组BALF中中性粒细胞均分别明显高于其他3个治疗组(P<0.01),HFOV+PLV组中性粒细胞均最低,HFOV+PLV组中性粒细胞比例和CMV+PLV组比较差异有显著性(P<0.01);各治疗组肺泡巨噬细胞(AM)的百分比均高于对照组。②细胞凋亡:HFOV+PLV组中性粒细胞早期凋亡率较其他3组高,HFOV组和HFOV+PLV组中性粒细胞早期凋亡率较CMV组和CMV+PLV组明显升高(P<0.01)。③总蛋白、丙二醛浓度各治疗组间的差异无显著性(P>0.05)。结论与其他3种通气模式相比,高频振荡通气联合部分液体通气能提高吸入性损伤兔肺泡中性粒细胞早期凋亡,减少肺组织内炎性细胞浸润。[Objective] To investigate effect of high frequency oscillatory ventilation and its combination with partial liquid ventilation on the apoptosis of polymorphonuelear cell in rabbit lung with acute respiratory failure induced by steam inhalation injury. [Methods] Forty New Zealand rabbits were randomly divided into five groups after acute respiratory failure models caused by severe steam inhalation injury were established. Four groups were ventilated 3.5 hours by CMV, HFOV, CMV＋PLV or HFOV＋PLV, respectively. The other group was given the oxygen therapy. Then all of them were killed. Each One underwent whole-lung lavage. Cells were removed from bronchoalveolar lavage fluid （BALF） by low-speed centrifugation, and the resulting pellets were analyzed for total cell, differential counts and apoptosis analysis. Total white-cell numbers were determined by manual counting. Cell-free lavage fluid was proessed for total protein （TP） and malondialdehyde （MDA） determinations. [Results] In the CMV group, the number of total and polymorphonuclear cell was obviously increased compared with other groups （P 〈0.01）, HFOV＋PLV have the lowest total and polymorphonuclear cell number. Polymorphonuclear ceil number in the CMV＋PLV and HFOV＋ PLV groups comparison showed significance （P 〉0.05）. Polymorphonuclear cell apoptosis in HFOV＋PLV group were higher than other group. There was significant difference when compared with CMV,HFOV or GMV＋PLV group. CMV group have the lowest polymorphonuclear Cell apoptosis. There was no significant difference between CMV and CMV＋PLV group. The level of total protein （TP） and malondialdehyde （MDA） was no significant difference among the CMV,HFOV,CMV＋PLV and HFOV＋PLV groups. [Conclusion] HFOV combined with PLV can increase polymorphonuclear ceil apoptosis, alleviate polymorphonuclear cell infiltration in inhalation lung injury.

关 键 词：高频振荡通气 部分液体通气 吸入性肺损伤 细胞凋亡 

分 类 号：R563[医药卫生—呼吸系统]