肺牵张反射对急性呼吸窘迫综合征的肺保护作用  

Protective effects of pulmonary stretch reflex on the lung injury in rabbits with acute respiratory distress syndrome

作　　者：吴晓燕[1] 黄英姿[1] 杨毅[1] 刘火根[1] 黄东亚[1] 汤睿[1] 邱海波[1] 

机构地区：[1]东南大学附属中大医院重症医学科,南京210009

出　　处：《中华急诊医学杂志》2011年第2期137-142,共6页Chinese Journal of Emergency Medicine

基　　金：江苏省自然科学基金（BK2008298）;江苏省＂科技兴卫工程＂医学领军人才基金（2007）;江苏省135重点人才基金（2006）;江苏省科技发展计划（BS2007045）;江苏省333高层次人才培养工程＂中青年科技领军人才基金

摘　　要：目的 观察肺牵张反射对急性呼吸窘迫综合征（ARDS）兔肺损伤的影响.方法 盐酸吸入法复制兔ARDS模型,应用神经电活动辅助通气（NAVA）进行机械通气,潮气量（VT）维持6 mL/kg,膈肌电活动（EAdi）法选择呼气末正压（PEEP）,随机（随机数字法）分为2组：（1）假手术（Sham）组（5只）;（2）迷走神经离断（VAG）组（5只）.观察在基础状态、ARDS成模、机械通气1,2,3 h时的气体交换及呼吸力学指标.测定肺通透性、病理以及炎症反应指标.结果 机械通气2,3 h,VAG组氧合指数（PaO2/FiO2）显著低于Sham组（P＜0.05）.在机械通气1,2,3 h时,VAG组二氧化碳分压（PaCO2）与Sham组差异无统计学意义（P＞0.05）,VAG组VT、气道峰压（Ppeak）及平均气道压（Pm）均显著高于Sham组（P＜0.05）.机械通气3 h,与Sham组相比,VAG组死腔分数（VD/VT）、肺弹性阻力（Ers）明显升高,肺静态顺应性（Cst）明显降低（P＜0.05）.与Sham组相比,VAG组肺组织湿/干质量（W/D）、肺损伤评分、肿瘤坏死因子-α（TNF-α）、白介素-8（IL-8）、髓过氧化物酶（MPO）及丙二醛（MDA）含最均显著升高（P＜0.05）.结论 离断迷走神经加重ARDS肺损伤,维持完整肺牵张反射对ARDS具有肺保护作用.Objective To evaluate the effect of the pulmonary stretch reflex on the lung injury in acute respiratory distress syndrome （ARDS）. Method ARDS models of rabbits were induced by intratracheal infusion hydrochloric acid and ventilated with neurally adjusted ventilatory assist （NAVA） with a tidal volume （ VT） of 6 mL/kg and the electrical activity of diaphragm （ Eadi）-determined PEEP level. The rabbits were randomly （ random number） divided into two groups： （ 1 ） sham operation （Sham） group （ n = 5 ）,（2） bilateral vagotom （VAG） group（ n = 5 ）. Gas exchange and pulmonary mechanics were determined at baseline, after lung injury and ventilation 1, 2, 3 h respectively. Indices about pulmonary permeability,pathological changes and inflammatory response were also measured. Results Compared with Sham group,the PaO2/FiO2in VAG group decreased significantly at ventilation 2 h, 3 h （P 〈0.05）. There was no significant difference on PaCO2 between Sham and VAG group （P 〉 0.05 ）, and VAG group had the higher VT,peak pressure （ Ppeak）, mean pressure （Pm） compared with Sham group at the time point of ventilation 1 h, 2 h, 3 h （P〈0.05）. Compared with Sham group, the dead space fraction （VD/VT） and the respiratory system elastance （Ers） in VAG group increased （P 〈 0.05 ） and the static pulmonary compliance （Cst）decreased markedly （P 〈 0.05 ） after 3 h ventilation. The wet/dry weight （W/D）, lung injury score, tumor necrosis factor-α （ TNF-α）, interleukin-8 （ IL-8 ）, myeloperoxidase （ M PO ） and malondialdehyde （ M DA ）in VAG group elevated significantly when compared with Sham group （ P 〈 0.05 ）. Conclusions The lung injury in ARDS was aggravated after bilateral vagotomy, which demonstrated that the pulmonary stretch reflex may have the lung protective effect.

关 键 词：肺牵张反射 迷走神经 肺损伤 急性呼吸窘迫综合征 膈肌电活动 肺力学 炎症反应 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]