大潮气量通气加重脂多糖所致急性肺损伤及谷氨酰胺的防护作用  

Large Tidal Volume Mechanical Ventilation Aggravates Acute Lung Injury and Protective Effects of Glutamine

作　　者：李金明[1] 孙宝君[1] 俞森洋[1] 刘庆辉[1] 

机构地区：[1]解放军总医院南楼呼吸科

出　　处：《中国呼吸与危重监护杂志》2010年第2期168-171,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：北京市自然科学基金资助项目(编号:7082088)

摘　　要：目的观察不同潮气量通气对脂多糖所致大鼠急性肺损伤的影响,以及谷氨酰胺的防护作用。方法将30只健康雄性SD大鼠随机分为三组。实施麻醉和气管切开后,气管内注入脂多糖(LPS)5mg/kg,接小动物通气机进行机械通气,A组实施常规潮气量通气,B组实施大潮气量通气,C组大潮气量通气前1h静脉注入谷氨酰胺干预。每小时行1次动脉血气分析。通气4h后颈动脉放血处死大鼠。测定全肺湿重,并计算肺系数(肺湿重/体重×100)。测定BALF中白细胞及中性粒细胞计数、蛋白含量、TNF-α、IL-6和中性粒细胞趋化因子1(CINC-1)水平,肺组织匀浆髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)水平。结果B组大鼠PaO2值、肺组织SOD水平较A组显著下降,肺系数、BALF中白细胞及中性粒细胞计数、蛋白含量、TNF-α、IL-6、CINC-1水平、肺组织MPO水平较A组显著增高;C组大鼠PaO2值、肺组织SOD水平较B组显著升高,肺系数、BALF中白细胞及中性粒细胞计数、蛋白含量、TNF-α、IL-6、CINC-1水平、肺组织MPO水平较B组显著下降。结论大潮气量通气能加重脂多糖所致大鼠急性肺损伤,而谷氨酰胺对此有较明显的防护作用。Objective To study the effects of two different tidal volume mechanical ventilation on lipopolysaccharide（LPS）-induced acute lung injury（ALI）,and explore the effects of glutamine on ALI.Methods Thirty male Sprague-Dawley rats were randomly divided into three groups.After anesthesia and tracheotomy were performed,the rats were challenged with intratracheal LPS（5mg/kg）and received ventilation for 4 hours with small animal ventilator.Group A received conventional tidal volume,while group B received large tidal volume.Group C received large tidal volume as well,with glutamine injected intravenously 1 hour before ventilation.Arterial blood gases were measured every one hour.4 hours later,the rats were killed by carotid artery bleeding.The total lung wet weight was measured and lung coefficient（total lung wet weight/body weight×100）was counted.WBCs and neutrophils in BALF were counted.Protein concentration,TNF-α,IL-6,and cytokine-induced neutrophil chemoattractant-1（CINC-1）levels in BALF,myeloperoxidase（MPO）,and superoxide dismutase（SOD）levels in the lung were assayed respectively.Results PaO2 and SOD levels decreased more significantly in group B than those of group A.The lung coefficient,WBCs,neutrophils,protein,TNF-α,IL-6,and CINC-1 levels in BALF,MPO levels in lung increased more significantly in group B than those of group A.PaO2 and SOD levels were significantly higher in group C than those of group B.The lung coefficient,WBCs,neutrophils,protein,TNF-α,IL-6,and CINC-1 levels in BALF,MPO levels in lung were significantly lower in group C than those of group B.Conclusion Large tidal volume mechanical ventilation aggravates LPS-induced ALI,and glutamine has obviously protective effects.

关 键 词：机械通气 脂多糖 肺损伤 谷氨酰胺 

分 类 号：R563.8[医药卫生—呼吸系统]