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重症医学科,湖北十堰442000

出　　处：《实用临床医药杂志》2013年第3期9-11,15,共4页Journal of Clinical Medicine in Practice

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支):对照组(Ⅰ组):插管后不行机械通气,静脉注射生理盐水5 mL。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:25 mL/kg。频率30次/min,吸呼比1∶3,FiO2为21%,PEEP为0 kPa,通气时间:24 h)。Ⅱ组:开始机械通气时静脉注射生理盐水5mL。Ⅲ组:静脉注射乌司他丁10万U、地塞米松5 mg/kg,用生理盐水稀释至5 mL。测定肺组织湿/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TNF-α、CC16、TGF-β1变化。结果Ⅱ组、Ⅲ组肺组织W/D、TNF-α、CC16、TGF-β1与Ⅰ组比较显著变化(P<0.001),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 dexam- ethasone in rabbits with ventilator induced lung injury. Methods Thirty healthy male rabbits were randomly divided into three groups（ 10 rabbits in each group）. The control group （group I ） received no mechanical ventilation after intubation, and were intravenously 5 mL physiological saline. High tidal volume mechanical ventilation group （ groupⅡ） and ulinastatin combined with dexamethasone group （ group Ⅲ ） were administered mechanical ventilation （ tidal volume, 25 mL/kg ; frequency, 30 times/ rain; respiratory absorption ratio, 1：3; PEEP, 0 kPa, FiO2, 21%; ventilation time, 24 h） Group 11 was intravenously injected with 5 mL physiological saline once mechanical ventilation started. Group m was intravenously injected with 100 000 U ulinastatin and 5 mg/kg dexamethasone. The wet and dry weight （W/D） ratio of lung tissue was 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. Resuits Lung tissue W/D, TNF-ct, CC16, and TGF-β1 in groupⅡ and group m were significantly higher compared with group I （P 〈 0. 001 ）. Lung tissue W/D and TNF-ct, CC16 and TGF-a1 in group mwere significantly reduced compared with group Ⅱ （P 〈0.01 ）. Lung tissue biopsy： lung tissue visible pulmonary interstitial and alveolar spaceedema, pulmonary inflammatory cell infiltration could be found in groupⅡ. Pulmonary edema was weaker in Group m compared with group Ⅱ. Conclusion Ulinastatin combined with dexametbasone has a protective effect on VLIL.

关 键 词：乌司他丁 地塞米松 机械通气 肺损伤 

分 类 号：R563[医药卫生—呼吸系统]