治疗性高碳酸血症对大鼠肺移植术时炎性反应的影响  

Effect of therapeutic hypercapnia on inflammatory response in rat lung transplantation

作　　者：高伟[1] 曾宪章[1] 张莉莉[1] 李文志[1] 崔晓光[1] 

机构地区：[1]哈尔滨医科大学附属第二医院麻醉科哈尔滨医科大学麻醉基础理论与应用研究实验室,150086

出　　处：《中华麻醉学杂志》2009年第11期1023-1025,共3页Chinese Journal of Anesthesiology

基　　金：国家自然基金科学部面上基金资助项目（30471655）

摘　　要：目的探讨治疗性高碳酸血症对大鼠肺移植术时炎性反应的影响。方法雄性Wistar大鼠48只，体重300～400g，随机分为肺移植术组（M组）和治疗性高碳酸血症组（H组），每组24只。M组再灌注期间吸入50％O2-50％N2混合气体；H组再灌注期间吸入N2-O2-CO2混合气体，调节3种气体吸入浓度，维持动脉血二氧化碳分压80～100mmHg，吸人氧浓度48％～50％。于机械通气15min时记录平均动脉压和动脉血氧分压作为基础值，再灌注期间每30min记录1次。于再灌注1、2和4h时各组随机取8只大鼠，采集外周动脉血样，采用酶联免疫吸附法测定血清TNF—α、IL-1和IL-8的浓度；取移植肺组织，测定弹性蛋白酶含量，计算肺湿／干重比，并行组织学观察。结果再灌注时H组平均动脉压和动脉血氧分压高于M组（P〈0．05）；与基础值比较，再灌注时M组TNF-α及IL-8的浓度升高（P〈0．05）；与M组比较，再灌注时H组TNF-α及IL-8的浓度降低（P〈0．05），再灌注2和4h时弹性蛋白酶含量、移植肺湿，干重比降低（P〈0．05）；H组移植肺组织肺泡内出血、巨噬细胞和中性粒细胞浸润及肺水肿较M组明显减轻。结论治疗性高碳酸血症可明显抑制大鼠肺移植术时的炎性反应。Objective To investigate the effect of therapeutic hypercapnia on the inflammatory response in the rat lung transplantation. Methods Male pathogen free Wistar rats weighing 300-400 g were used in this study. The animals were anesthetized with 3% pentobarbital sodium 30 mg/kg, tracheostomized and mechanically ventilated （VT 10 ml/kg, RR 50 bpm, FiO2 50%）. Carotid artery and femoral vein were cannulated for BP monitoring, blood sampling and fluid and drug administration. Left lung transplantation was performed using modified cuff technique. Forty-eight animals in which lung transplantation was successfully performed were randomized into 2 groups （n = 24 each） ： model group （M） and hypercapnia group （H） . In group H, PaCO2 was maintained at 80-100 mm Hg by inhalation of CO,. Arterial blood samples were obtained before lung transplantation （To, baseline） and at 1, 2, 4 h （T1-3 ） of reperfusion for determination of blood TNF-a, IL-1 and IL-8 concentrations. The animals were then killed and the transplanted lungs were removed for microscopic examination and calculation of wet/dry lung weight ratio. Results The MAP and PaO2 were significantly higher in group H than in group M. The blood IL-8 and TNF-α concentrations were significantly lower at T1-3 in group H than in group M, but there was no significant difference in blood IL-1 concentration between the 2 groups. The elastase content in the lung tissue was significantly lower at T2 and T3 in group H than in group M. Microscopic examination showed that the alveolar hemorrhage, the infiltration of the lung by macrophages and neutrophils and lung edema were significantly less in group H than in group M. Conclusion Therapeutic hypercapnia can obviously inhibit the inflammatory response in the rat lung transplantation.

关 键 词：高碳酸血 肺移植 再灌注损伤 炎症 

分 类 号：R655.3[医药卫生—外科学]