呼吸机所致肺损伤家兔模型的建立与评价  

Establishment and Evaluation of Rabbit Model of Ventilator-Induced Lung Injury

作　　者：安莉[1] 周美玲[1] 秦雪冰[1] 刘庆辉[1] 刘长庭[1] 俞森洋[1] 

机构地区：[1]解放军总医院南楼呼吸科,北京100853

出　　处：《中国呼吸与危重监护杂志》2010年第2期163-167,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：北京市自然科学基金项目(编号:7082088)

摘　　要：目的建立呼吸机所致肺损伤家兔模型并进行评价。方法40只家兔随机分为3组:常规8mL/kg潮气量组(VT8组)、25mL/kg大潮气量组(VT25组)、40mL/kg大潮气量组(VT40组);除了VT8组外,VT25和VT40组内再分为2h和4h机械通气两个亚组。监测通气过程中的动脉血气、肺机械力学和血流动力学变化;肺组织HE染色观察肺损伤情况;测定肺湿/干比、BALF蛋白浓度,计数BALF中有核细胞和中性粒细胞数目。比较不同通气条件下家兔的肺损伤程度和重要的生理参数,确定复制呼吸机所致肺损伤家兔模型的最适条件。结果与VT8组相比较,大潮气量通气组的肺损伤评分显著升高,其中以VT40通气4h亚组最高。VT40组镜下可见肺泡结构变形,肺间质及肺泡腔渗出,炎症细胞浸润,部分肺组织实变及肺泡出血。VT25组则主要表现为肺间隔增厚,炎症细胞浸润,肺泡腔内渗出较少。随通气时间延长,大潮气量通气组的PaO2/FiO2呈下降趋势,其中VT40组在通气3h(<300mmHg)已符合急性肺损伤标准,而VT25组在各时间点PaO2/FiO2均在300mmHg以上。大潮气量通气组的肺湿/干比、BALF蛋白浓度及细胞数较VT8组有显著升高,并随通气时间延长而增加,以VT40通气4h亚组最高。结论使用潮气量40mL/kg通气4h能够复制出理想的呼吸机所致肺损伤家兔模型。Objective To establish a rabbit model of ventilator-induced lung injury.Methods Fourty healthy New Zealand rabbits were randomly divided into 3 groups：ie.a routine 8 mL/kg tidal volume group（VT8 group）,25 mL/kg large tidal volume group（VT25 group）,and 40 mL/kg large tidal volume group（VT40 group）.VT25 and VT40 group were further divided into 2 hours and 4 hours ventilation subgroups.Arterial blood gas,lung mechanical force and hemodynamic parameters were monitored.Lung tissue was sampled for evaluate lung wet/dry ratio and lung injury by HE stain.Bronchoalveolar lavage fluid（BALF）was collected for measurement of protein concentration,total and differential cell counts.Results Compared with VT8 group,lung injury score in both VT40 and VT25 groups were elevated significantly,of which 4 hour VT40 subgroup was the highest.Lung pathology examination of VT40 group revealed apparent alveolar deformation,interstitial and alveolar space exudation,inflammatory cells infiltration,pulmonary consolidation and alveolar hemorrhage.Lung pathology examination of VT25 group showed pulmonary interval thickening,inflammatory cells infiltration,while alveolar intravasation was mild.Blood gas analysis showed that PaO2/FiO2 was deteriorated with time in VT25 and VT40 groups,and PaO2/FiO2 at the 3 hours in VT40 group（300 mm Hg）had met the acute lung injury standard,while which in VT25 group was above 300 mm Hg.Lung wet/dry ratio,BALF protein concentration,total nucleated cell and neutrophilic leukocyte were elevated in both VT25 and VT40 groups,of which 4 hours VT40 group was the highest.Conclusion Using 4 hours ventilation at a tidal volume of 40 mL/kg can successfully establish the rabbit model of ventilator-induced lung injury.

关 键 词：呼吸机所致肺损伤 机械通气 动物模型 家兔 

分 类 号：R563.8[医药卫生—呼吸系统] R-332[医药卫生—内科学]