高频振荡通气和常频机械通气对吸人性损伤兔心肌功能影响的比较研究  

Comparing the effect of high frequency oscillatory ventilation and conventional mandatory ventilation on the myocardial function of rabbit with inhalation injury

作　　者：郭光华[1] 王少根[3] 付忠华[1] 杨明[2] 吴星恒[2] 朱峰[1] 

机构地区：[1]南昌大学第一附属医院烧伤科,330006 [2]南昌大学第一附属医院儿科,330006 [3]皖南医学院弋矶山医院烧伤科

出　　处：《中华烧伤杂志》2010年第4期300-303,共4页Chinese Journal of Burns

基　　金：基金项目：国家自然科学基金（30460134）

摘　　要：目的 比较高频振荡通气（HFOV）和常频机械通气（CMV）对吸入性损伤兔心肌功能的影响. 方法 将16只新西兰大白兔制成蒸气吸入性损伤模型后,按随机抽签法分为CMV组和HFOV组,每组8只,分别行定容通气和HFOV治疗.4 h后处死2组家兔,处死前经心脏采血,检测血浆中乳酸脱氢酶1（LDH1）和心肌型肌酸磷酸激酶同工酶（CPK-MB）活性.取家兔左心室部分组织并匀浆,用ELISA法检测TNF-α、IL-8含量,分光光度法测定半胱氨酸天冬氨酸蛋白酶1（caspase-1）活性;核素液体闪烁技术测定心肌组织肌球蛋白轻链（MLC）-ATP酶和肌球蛋白轻链激酶（MLCK）活性.部分左心室心肌组织送病理检查.对实验数据行方差分析. 结果 （1）CMV组家兔血浆LDH1、CPK-MB活性分别为（643±108）、（342±48）U,明显高于HFOV组此2项指标[（233±92）、（186±36）U,F值分别为10.326、9.846,P值均小于0.01].（2）CMV组家兔心肌组织匀浆中TNF-α、IL-8含量和caspase-1活性分别为（181±35）pg/g、（89±19）pg/g、（0.56±0.27）g/g蛋白,均明显高于HFOV组[（94±21）pg/g、（43±11）pg/g、（0.24±0.12）g/g蛋白,F值分别为8.239、7.826、5.716,P值均小于0.01].（3）CMV组心肌组织MLC-ATP酶、MLCK活性分别为（0.24±0.12）μmo1·mg-1·min-1、（3.3±1.1）mmol·mg-1·min-1,均明显低于HFOV组[（0.48±0.16）μmol·mg-1·min-1、（7.7±1.7）mmol·mg-1·min-1,F值分别为4.125、4.766,P值均小于0.01].（4）光学显微镜下可见,2组家兔心肌组织无明显坏死、变性及炎性细胞浸润现象,但心肌纤维略显肿胀,HFOV组改变不及CMV组明显. 结论 与CMV模式比较,HFOV模式对吸人性损伤兔心肌肌球蛋白磷酸化系统影响较小.Objective To compare the effect of high frequency oscillatory ventilation （HFOV） and conventional mandatory ventilation （CMV） on the myocardial function of rabbits with inhalation injury.Methods Steam inhalation injury model was reproduced in 16 New Zealand albino rabbits. They were randomly divided into CMV group（n =8） and HFOV group（n =8） by drawing lots, and they received ventilation in metered volume and HFOV treatment respectively. Heart blood was drawn from rabbits before they were sacrificed 4 hours after treatment to determine the plasma activity of lactate dehydrogenase 1（LDH1）and creatine phosphorylated kinase （CPK-MB）. Myocardial tissue from left ventricle was harvested and homogenized to determine the concentration of TNF-α and IL-8, the activity of caspase-1, and the activity of myosin-light-chain kinase （MLCK） and the ATPase of myosin light chain （MLC-ATPase） by enzyme-linked immunosorbent assay, spectrophotometry, and the nuclide liquid scintillation technique respectively. Part of the myocardial tissue sample was examined pathologically. Data were processed with analysis of variance.Results （1） The activities of LDH1 and CPK-MB in plasma were obviously higher in CMV group than in HFOV group [（643 ± 108）, （342 ±48） U vs. （233 ±92）,（186 ± 36） U, with F value respectively 10. 326 and 9. 846, P values all below 0.01]. （2） The contents of TNF-αt, IL-8 and the activity of caspase-1in myocardial tissue homogenate were obviously higher in CMV group than in HFOV group [（181 ± 35） ,（89±19） pg/g, and （0.56±0.27） g/g protein vs. （94±21）, （43 ±11） pg/g, and （0.24±0.12） g/gprotein, with F value respectively 8. 239, 7. 826, 5. 716, P values all below 0. 01]. （3） The activities of MLC-ATPase and MLCK were lower in CMV group than in HFOV group [（0.24 ±0. 12） μmol ·mg-1min-1, （3.3± 1.1） mmol· mg-1 · min-1 vs. （0.48 ±0. 16） μmol ·mg-1 · min-1, （7.7 ± 1.7）mmol· mg-1 · min - 1, with F value resp

关 键 词：烧伤 吸入性 高频通气 心肌 肌球蛋白轻链 肌球蛋白轻链激酶 半胱 氨酸天冬氨酸蛋白酶1 常频机械通气 

分 类 号：R722.1[医药卫生—儿科]