氯胺酮雾化吸入对机械通气致肺损伤模型家兔SP-A及SOD、MPO的影响  

Nebulized inhalation of ketamine attenuates ventilator-induced ling injury in rabbits and its relation to surfacant protein A,superoxide dismutase,myeloperoxidase levels

作　　者：丰浩荣[1] 王祥和[1] 葛伟[2] 许鹏程[2] 

机构地区：[1]中国人民解放军第98医院麻醉科,湖州313000 [2]徐州医学院江苏省麻醉学重点实验室

出　　处：《浙江医学》2014年第4期262-266,共5页Zhejiang Medical Journal

基　　金：南京军区科技创新课题(09MA009);浙江省湖州市科技局自然科学基金项目(2009YSB20)

摘　　要：目的探讨氯胺酮雾化吸入对呼吸机所致肺损伤(VIL-I)兔模型的保护作用机制。方法选取48只家兔,按随机数字表法分为自主呼吸组(C组)、呼吸机损伤模型组(V组)、0 9%氯化钠溶液雾化吸入组(NS组)和不同浓度氯胺酮处理组(分别为K1组、K2组和K3组),每组8只。除C组外,其他组均给予大潮气量通气(VT=40ml/kg)4h,K1、K2、K3、NS组在给予大潮气量通气同时间断雾化吸入容量为4ml/(kg·h)、浓度为12.5、25、50 mg/ml的氯胺酮或等量0.9%氯化钠溶液(持续10min)。连续监测平均动脉血压(MAP)、心率(HR)及气道峰压(P_(peak))、平台压(P_(plat))变化,每间隔1h测定动脉氧分压(PaO_2),计算PaO_2/FiO_2。持续通气4h后测定肺组织中髓过氧化物酶(MPO)及超氧化物歧化酶(SOD)活性和肺表面活性物质相关蛋白(SP-A)水平。结果C组MAP及HR均较为稳定,V组、K组、NS组内随着通气时间的延长,MAP及HR呈不同程度下降,其中V组、NS组较K组下降更为显著,K组中K3组下降相对较少。C组通气过程中P_(peak)、P_(plat)相对稳定,V组、K组、NS组在通气过程中P_(peak)、P_(plat)均呈上升趋势,其中V组、NS组升高最为显著,与V组同一时点相比,K3组P_(peak)、P_(plat)显著降低(P<0.05)。C组在整个实验过程中PaO_2/FiO_2无明显变化,其他各组PaO_2/FiO_2在呼吸机通气1h后均有所升高,通气2h后开始逐渐下降,通气4h时V组和NS组下降最为明显,K组下降程度比V组和NS组趋缓。通气4h时K1、K2组的PaO_2/FiO_2高于V组,但无统计学差异(P>0.05),K3组显著高于V、NS、K1、K2组,差异均有统计学意义(均P<0.05)。与C组比较,V组和NS组肺组织中SOD活性和SP-A水平降低,MPO活性升高(P<0.05)。与V组比较,K3组肺组织中SOD活性和SP-A浓度升高,MPO活性降低,且差异均有统计学意义(均P<0.05)。结论高浓度氯胺酮雾化吸入对机械通气所致兔肺损伤有保护作用,该作用与氯胺酮雾化吸入减少肺表面物质的破坏�Objective To investigate the protective effect of nebulized inhalation of ketamine on ventilator- induced lung injury in rabbits and its mechanism. Methods Forty eight adult rabbits were randomly divided into six groups with 8 in each group：control group（C）, lung injury group（V）, normal saline group（NS） and 3 ketamine groups（K1 , K2 , K3）. Al rabbits were giv-en large tidal volume ventilation （VT=40mL/kg, respiratory rate 12/min） for 4h except control group. Rabbits in K groups inhaled 4ml/（kg·h） of 12.5mg/ml, 25 mg/ml or 50mg/ml nebulized ketamine for 10 min/h;rabbits in NS group inhaled 4ml/（kg·h） of nebu-lized normal saline for 10min/h. The mean arterial blood pressure （MAP）, heart rate （HR）, the peak airway pressure （Ppeak） and plateau pressure （Pplat） were continuously monitored, the PaO2/FiO2 value was calculated by measuring the arterial oxygen （PaO2） at intervals of 1h. The lung tissue samples was col ected 4 h after treatment, and the activities of myeloperoxidase （MPO）, super-oxide dismutase （SOD） and the surfacant protein A （SP- A） contents in lung tissue were detected. Results The MAP and HR in group C were relatively stable during the experiment, while decreased in group V, group K, group NS with prolonged ventilation. The MAP and HR in group V, group NS decreased more markedly than those in group K;and those in group K3 were decreased least. The Ppeak and Pplat were relatively stable during ventilation, while the indexes in group V, group K and group NS showed an upward trend, and it was the most significant in group V and group NS. Compared to those indexes in group V at the same time points, those is group K3 were significantly lower （P〈0.05）. The PaO2/FiO2 in group C was not significantly changed during the experience, but it increased 1h after ventilation in other groups, then declined at 2h after ventilation and decreased significantly 4h after ventilated in groups V and NS, the decrease tended to become moderated in the grou

关 键 词：雾化吸入 氯胺酮 机械通气 呼吸机相关性肺损伤 

分 类 号：R-332[医药卫生] R563.8