兔胸腔内注射滑石粉致肺及肺外全身系统性播散  

Extrapleural Talc Dissemination of Intrapleural Injection of Different Talc Preparation in Rabbits

作　　者：廖槐[1] 谢灿茂[1] 

机构地区：[1]中山大学附属第一医院呼吸内科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2013年第6期861-866,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(A2011159)

摘　　要：【目的】观察不同颗粒大小滑石粉胸膜固定术后肺及肺外器官的播散变化,以初步探讨滑石粉相关急性呼吸窘迫综合征(ARDS)的发生机制。【方法】建立滑石粉胸膜固定术的实验动物模型,将36只健康雄性清洁级新西兰白兔按随机数字表法分为3组:大滑石粉组(n=12)、小滑石粉组(n=12)和多西环素(Doxycycline)组(n=12)。实验动物经胸腔导管各注入大、小滑石粉匀浆(400 mg/kg)和多西环素(10 mg/kg),引起兔子右侧胸膜炎症及粘连。分别于胸膜粘连术后24 h和第7天处死半数实验动物,解剖留取双肺、肝、肾等器官,评价大体胸膜粘连程度、镜下病理变化及滑石粉播散情况。【结果】胸膜内注射粘连剂7 d后,在大、小滑石粉组和Doxycycline组均可引起明显的脏层胸膜的纤维化。胸膜纤维化指数在大滑石粉组为2.5±0.8,小滑石粉组为1.8±0.8,Doxycycline组为2.2±0.4,三组之间没有统计学差异(P>0.05)。滑石粉胸腔内注射后,在大、小滑石粉组均有双侧肺内滑石粉的播散,而Doxycycline组没有观察到滑石粉颗粒的播散。小滑石粉组的肺及肺外器官滑石粉颗粒数明显多于大滑石粉组。大、小滑石粉组的肺及肺外器官播散滑石粉颗粒同样为小直径的滑石粉颗粒。部分小滑石粉组实验动物可观察到滑石粉肺内播散伴有周围肺泡及间质的炎症改变。【结论】胸腔内注射小滑石粉较大滑石粉导致更显著的包括双肺、肾脏、脾脏等全身器官的小直径滑石粉颗粒播散。肺内滑石粉颗粒的沉积,可导致周围肺泡的炎症。[Objective] To explore the mechanisms of talc related ARDS by studying the pleurodesis efficacy,talc particles deposition throughout the body after the intrapleural injection of two types of talc with different mean particles sizes in rabbits.[Methods] Three groups of twelve rabbits were assigned to administer intrapleurally with 400 mg/kg of big talc,400 mg/kg of small talc and 10 mg/kg of doxycycline.Samples from ipsilateral and contralateral lung,spleen and kidney were obtained at 24 h and 7 days and evaluated macroscopically and microscopically.[Results] The intrapleural administration of big talc,small talc,and doxycycline induced pleural fibrosis （2.5 ± 0.8,1.8 ± 0.8,and 2.2 ± 0.4,respectively,P〉 0.05） at 7 days.Both the rabbits treated with big talc and small talc showed talc particles deposited in the ipsilateral （right） and contralateral （left） lung whereas rabbits treated with doxycycline did not.The rabbits treated with the small talc had significantly more talc deposition in lung and extrapulmonary organs （spleen,liver and kidney） than did the rabbits treated with big talc.Talc particles deposited in pulmonary and extrapulmonary organs are small size regardless of whether the animal received big talc or small talc,while some rabbits treated with small talc can find obvious talc deposition in lungs and cause lung alveolar inflammation.[Conclusion] The results demonstrate that the intrapleural administration of small talc has more systemic dissemination than big talc and may be related to lung alveolar inflammation.

关 键 词：滑石粉 胸膜固定术 副作用 急性呼吸窘迫综合征 肺 肝 肾 脾 

分 类 号：R561.1[医药卫生—呼吸系统]