乌司他丁联合地塞米松对机械通气大白兔肺保护研究  

Protective effects of ulinastatin combined with dexamethasone in rabbits with ventilator induced lung injury

作　　者：刘伯毅[1] 郑晓丽[1] 郑翔[1] 方志成[1] 刘培[1] 

机构地区：[1]湖北医药学院附属太和医院,442000

出　　处：《山西医药杂志（下半月）》2013年第1期3-5,共3页Shanxi Medical Journal

基　　金：湖北省十堰市科技攻关项目(2009045D)

摘　　要：目的探讨乌司他丁联合地塞米松对呼吸机相关性肺损伤(VILI)大白兔肺保护中的作用。方法将30只健康雄性大白兔随机分成3组(每组各10只)。对照组(Ⅰ组)插管后不行机械通气,静脉注射生理盐水5mL;大潮气量机械通气组(Ⅱ组)及乌司他丁联合地塞米松干预组(Ⅲ组)插管后机械通气[潮气量:25mL/kg,频率:30次/min,吸呼比:1∶3,吸入气体中氧浓度(FiO2)为21%,呼气末正压(PEEP)为0cmH2O,通气时间:24h]。Ⅱ组:开始机械通气时静脉注射0.9%氯化钠注射液5mL;Ⅲ组静脉注射乌司他丁10万U、地塞米松5mg/kg,用0.9%氯化钠注射液稀释至5mL。测定肺组织湿质量/干质量(W/D)值、制备肺组织石蜡切片,在显微镜下观察肺组织病理学变化,并检测肺组织肿瘤坏死因子(TNF)-α、CC16、转化生长因子(TGF)-β1变化。结果Ⅱ组、Ⅲ组肺组织W/D、TNF-α、CC16、TGF-β1与Ⅰ组比较,差异有统计学意义(P<0.01);同时,Ⅲ组相应指标较Ⅱ组也明显变化(P<0.01)。肺组织病理切片:Ⅱ组可见肺间质和肺泡腔水肿,肺内炎性细胞浸润;Ⅲ组较Ⅱ组肺水肿轻。结论乌司他丁联合地塞米松在机械通气过程中有肺保护作用,可防治VILI。Objective To explore the protective effects of ulinastatin combined with dexamethasone in rab- bits with ventilator induced lung injury. Methods Thirty healthy male rabbits were randomly divided into three groups（10 rabbits in each group）： control group （group Ⅰ ）：without mechanical ventilation after intubation, and were intravenously administered 5 mL physiological saline. High tidal volume mechanical ventilation group （group 11 ） and ulinastatin combined with dexamethasone group （groupⅢ ） were given mechanical ventilation： tidal vol- ume：25 mL/kg, frequency： 30 times/min, respiratory absorption ratio： f 1 ： 3, PEEP： 0 cm H2O , FiOz ： 21%, ventilation time： 24 h. Group Ⅱ were intravenously administered 5 mL physiological saline when starting mechani- cal ventilation. Group Ⅲ were intravenously administered 100 000 U ulinastatin and 5 mg/kg dexamethasone. The wet and dry weight （W/D） ratio of lung tissue were calculated. Lung tissue sections were prepared for biopsies, The lung tissue specimens were collected for detecting the levels of TNF-a,CC16 and TGF-β1. Results Group Ⅱ , group HI lung tissue W/D, TNF-a,CC16 and TGF-βl were significantly higher compared with group Ⅰ（P〈 0. 01）. Group HI lung tissue W/D, TNF-a, CC16and TGF-β1 significantly reduced compared with group Ⅱ （P〈 0.01）. Lung tissue biopsy： lung tissue visible pulmonary interstitial and alveolar space edema, pulmonary inflam- matory cell infiltration could be found in group Ⅱ. Group Ⅲ pulmonary edema weak comparison group Ⅱ. Conclusion Ulinastatin combined with dexamethasone has a protective effect on VLIL.

关 键 词：地塞米松 肺损伤 乌司他丁 通气机 机械 

分 类 号：R654.2[医药卫生—外科学]