不同潮气量致新生大鼠呼吸机相关性肺损伤的特点  

Feature of Ventilation Induced Lung Injury with Different Tidal Volume in Neonatal Rats

作　　者：黄进洁 吴本清 丁璐 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院新生儿科,广东深圳518020

出　　处：《实用儿科临床杂志》2010年第14期1052-1054,共3页Journal of Applied Clinical Pediatrics

基　　金：深圳市医学重点学科专项基金(20091998A03)

摘　　要：目的探讨不同潮气量致新生大鼠呼吸机相关性肺损伤(VILI)的临床特点。方法新生大鼠32只。随机分为对照组(无通气)、常规通气组(潮气量0.010 L.kg-1,通气5 h)、过度通气5 h组(潮气量0.025 L.kg-1,通气5 h)和过度通气3 h组(潮气量0.025 L.kg-1,通气3 h)。机械通气后测定其肺质量,计算肺系数,观察其病理变化,进行肺损伤评分,ELISA法检测其肺组织IL-6、IL-10水平。结果过度通气5 h组、过度通气3 h组、常规通气组和对照组肺损伤病理评分分别为(9.63±1.40)分、(4.40±1.06)分、(6.50±1.85)分和0.00分,4组间比较差异有统计学意义(P=0.000)。过度通气5 h组、过度通气3 h组、常规通气组和对照组肺组织IL-6水平分别为(785.33±39.06)pg.g-1、(656.78±48.82)pg.g-1、(701.6±33.65)pg.g-1和(635.02±65.78)pg.g-1,4组间比较差异有统计学意义(P=0.000)。肺组织IL-6水平与肺损伤评分呈正相关(r=0.78,P<0.01)。各组间IL-10水平比较差异无统计学意义(P=0.940)。过度通气5 h组IL-6/IL-10比值较其他3组明显升高(P<0.05)。结论新生大鼠VILI与潮气量大小和通气时间有关,过度通气可导致严重肺损伤。肺组织IL-6水平与肺损伤程度呈正相关,致炎-抑炎因子失衡是VILI生物伤机制之一。Objective To investigate the feature of ventilation induced lung injury （VILI） with different tidal volume in neonatal rats. Methods Thirty -two neonatal rats were assigned to control group（ without ventilation）, conventional ventilation group （tidal volume 0. 010 L·kg^-1 for 5 h）, hyperventilation 5 h group （ tidal volume 0. 025L·kg^-1 for 5 h）, hyperventilation 3 h group （ tidal volume 0. 025L·kg^-1 for 3 h） randomly. After ventilation, the lungs were obtained to weigh, score about the degree of lung pathologic injury was count. The levels of IL - 6 and IL - 10 of lung tissue were detected by enzyme - linked immunosorbent assay. Results The VILI histopathalogy score in hyperventilation 5 h group, hyperventilation 3 h group, conventional ventilation group and control group were 9.63 ± 1.40,4.40 ± 1.06,6.50±1.85 and 0.00, respectively, the differences were significant mnong the 4 groups （ P = 0. 000）. IL - 6 in hyperventilation 5 h group, hyperventilation 3 h group, conventional ventilation group and control group were （785.33 ± 39.06）pg·g^-1, （656.78± 48.82）pg·g^-1, （701.6 ± 33.65 ）pg·g^-1 and （635.02 ±65.78 ）pg·g^-1, there were significant differences among the 4 groups （ P = 0. 000）. The IL - 6 level was positively correlated with VILI histopathology score （ r = 0.78, P 〈 0.01 ）. There was no significant difference of IL - 10 level among the 4 groups （ P =0. 940）. The ratio of IL - 6/IL - 10 was significantly higher in hyperventilation 5 h group compared with the other groups （P 〈 0.05 ）. Conclusions VILI in neonatal rats is related with tidal volume and duration of ventilation,hyperventilation may induce serious lung injury. The level of IL-6 in lung tissue is correlated with the degree of lung injury positively. The imbalance of inflammantiflam cytokine is one of mechanism of biotrauma in VILI.

关 键 词：机械通气 肺损伤 潮气量 白细胞介素 鼠 新生 

分 类 号：R722.1[医药卫生—儿科]