不同潮气量机械通气对复苏犬支气管灌洗液中Toll样受体4变化的影响  

Changes of TLR4 in dog bronchoalveolar lavage fluid with different tidal volumes mechanical ventilation during cardiopulmonary resuscitation

作　　者：刘勇[1] 黄亮[1] 杨继斌[1] 刘坚[1] 

机构地区：[1]南昌大学第一附属医院急诊科,江西南昌330006

出　　处：《中国急救医学》2012年第8期704-708,I0002,共6页Chinese Journal of Critical Care Medicine

基　　金：江西省卫生厅科技计划项目（20081023）

摘　　要：目的观察不同潮气量（Vt）机械通气对室颤犬复苏后肺泡灌洗液中Toll样受体4（TLR4）的影响，探讨心肺复苏（CPR）后肺损伤机制及机械通气治疗策略。方法选用健康成年犬24只，体质量（15±2）kg，雌雄不限，随机分为两组：对照组（A组，n=8）仅进行麻醉和气管插管；实验组（B组，n=16）经右心室导管诱发室颤制作心脏骤停模型，根据不同Vt机械通气分为两个亚组，小Vt组（B，组，n=8）：Vt为6mL／kg；大Vt组（B2组，n=8）：Vt为20mL／kg；实验组所有犬给予机械通气6h，观察开始复苏前及机械通气后不同时间点各组犬动脉血气的变化；应用酶联免疫吸附实验（ELISA）检测支气管灌洗液中TLR4含量；比较各组犬复苏成功率及72h存活情况，测定肺组织病理形态学积分。结果复苏开始时各亚组犬pH显著降低，PaO2下降，PaCO2上升，与基础值比较差异有统计学意义（P〈0．05），复苏后两亚组pH、PaO2均升高；B2组自主循环恢复（ROSC）2h后，PaCO2较B，组下降（P〈0．05）；ROSC6h后，B1组与B2组HC03-比较差异有统计学意义（P〈0．05）；复苏成功率和72h存活率分别为B，组26／8和3／6，B：组：5／8和2／5，组问比较差异均无统计学意义（P〉0．05）；支气管灌洗液中TLR4含量B组明显高于A组（P〈0．01），B，组含量较啦组低（P〈0．05）；与B，组比较，B2组病理损伤形态学积分升高（P〈0．05）。结论大小潮气量机械通气均能有效地改善复苏后低氧血症，小潮气量机械通气能减少肺TLR4的表达，减轻复苏后肺损伤。Objective To observe the changes of Toll - like receptor 4 in dog bronchoalveolar lavage fluid with different tidal volumes （Vt） mechanical ventilation during cardiopulmonary resuscitation. Discuss the mechanism of lung injury after cardiopulmonary resuscitation and mechanical ventilation strategy. Methods A total of 24 healthy, adult and mongrel canines were randomly divided into control group （group A： no ventricular fibrillation and mechanical ventilation） and experiment group （ group B ： ventricular fibrillation was induced with pacing catheter put through right external carotid vein into the right ventricle , CPR was initiated with different Vt mechanical ventilation after 3 rain of ventricular fibrillation）. The experiment group were divided into B1 and B2 two subgroups based on the Vt. B1 ：Vt 6 mL/kg body weight; B2 ： Vt 20 mL/kg body weight. Ventilation in both subgroups was maintained for 6 hours. The indexes of arterial blood gas was tested in different times. The consistency of toll like receptor 4 in bronchia alveolus lavage fluid （BALF） was tested in ELISA. Comparing the rate of The rate of successful return of spontaneous circulation（ROSC） and the 72 h survival rate, observing the pathological changes of lung tissue in each group. Results After ventricular fibrillation, pH, PaO2 , in both subgroups were decreased, PaCO2 was raised （ P 〈 0.05 ）. After ROSC pH, PaO2, in both subgroups were elevated, the decline of PaCO2 in group B2 has statistical significance with B1 in 2 hours after ROSC. The different of HCO3- between B1 and B2 has statistical significance in 6 hours after ROSC. The rate of successful return of spontaneous circulation（ROSC） and the 72 h survival rate were ： B1 6/8, 3/6; B2 5/8, 2/5. They were no statistically significant（P 〉0.05） . The protein of TLR4 in BALF in group B were greatly increased as compared with the group A（ All P 〈0.01 ）, while group B2 increased much more than Bl （P 〈 0.01 ）, and the morphological change scor

关 键 词：心肺复苏(CPR) 机械通气 肺损伤 Toll样受体4(TLR4) 潮气量(Vt) 

分 类 号：R563.8[医药卫生—呼吸系统]