小潮气量通气对肺损伤兔外周血中TNF-α、IL-6、IL-8、MMP-9表达的影响  

The effects of low tidal volume ventilation on expressionless of TNF-α, IL-6, IL-8 and MMP-9 of peripheral blood on acute lung in injury rabbits

作　　者：秦鑫[1] 秦蕾[2] 刘又宁[3] 

机构地区：[1]山西医科大学第二医院呼吸内科,太原030001 [2]北京老年医院普外科,100095 [3]解放军总医院呼吸内科,北京100853

出　　处：《中华临床医师杂志（电子版）》2015年第9期121-125,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的小潮气量机械通气对内毒素性急性肺损伤(ALI)动物模型外周血中TNF-α、IL-6、IL-8、MMP-9表达的影响。方法健康新西兰白兔24只,平均体重(2.48±0.30)kg,随机分为3组:(1)急性肺损伤小潮气量机械通气组(ALI+LV组):通过气道内滴入脂多糖(LPS)(2.5 mg/kg)制作急性肺损伤动物模型,然后在小潮气量机械通气持续24 h(容量控制VT:6 ml/kg;f:40/min;Fi O2:0.6;I∶E 1∶1.5;PEEP 5 cm H2O)。(2)急性肺损伤组(LPS组):气道内滴入LPS。(3)正常对照组(C组):气道内注入与LPS相同剂量的生理盐水。实验期间于0 min,30 min,1 h,2 h,4 h,6 h,8 h,12 h,24 h各抽取动脉血1 ml,测动脉血氧分压(Pa O2),静脉血2 ml,用ELISA技术检测血浆TNF-α、IL-6、IL-8、MMP-9表达情况。实验开始24 h后处死动物,取左肺测湿/干(W/D)重比。结果 (1)ALI组较对照组外周血中TNF-α、IL-6、IL-8、MMP-9表达明显升高,并且随时间延长逐渐增加。(2)LV+ALI组与ALI组比较,外周血中TNF-α、IL-6、IL-8、MMP-9在6 h之前差异无显著性,在6 h后显著减低,且随时间延长,降低的幅度越大,效果越明显。(3)气道滴入LPS后,ALI组较对照组Pa O2显著减低(P<0.05),低氧血症逐渐加重。经小潮气量通气后,LV+ALI组较ALI组6 h后低氧血症明显改善,W/D值明显下降(P<0.05)。结论小潮气量机械通气不能改善炎症性肺损伤早期外周血中炎症因子水平,但可以明显减低晚期炎症性肺损伤外周血中炎症因子,可能和小潮气量改善晚期肺泡通气有关。Objective To investigate the effects of low tidal volume ventilation on expressionless of TNF-α, IL-6, IL-8 and MMP-9 in intratracheal lipopolysaccharide （LPS）-induced acute lung injury rabbit. Methods Twenty-four healthy New Zealand rabbits were randomly divided into three groups： C group （no intratracheal LPS instillation, spontaneous breath）, ALI group （intratracheal LPS instillation, spontaneous breath）, ALI＋LV group （intratracheal LPS instillation with low tidal volume ventilation, CV：VT：6 ml/kg, f：40/min, FiO2：0.6, I∶E 1∶1.5, PEEP 5 cmH2O）. The contents of TNF-α, IL-6, IL-8 and MMP-9 were measured in serum by enzyme-linked immunosorbent assay （ELISA） at 0 min, 30 min, 1 h, 2 h, 4 h, 6 h, 8 h, 12 h, 24 h. Meanwhile, PaO2 were determined, and left lung W/D was assessed after animal sacrificed. Results In the ALI group, the contents of TNF-α, IL-6, IL-8 and MMP-9 were increased significantly（P all〈0.05）. Compared with C group, and increasing gradually with prolonged time. In the ALI＋LV group, the contents of TNF-α, IL-6, IL-8 and MMP-9 were significantly （P〈0.05）.decreased after 6 h, but were not different （P〉0.05）. before 6 h, compared with ALI group. PaO2 were decreased significantly （P〈0.05） in ALI group compared with C group and improved significantly （P〈0.05） in the ALI＋LV group after 6 h. Left lung wet/dry （W/D） weight were decreased significantly （P〈0.05） in ALI＋LV group compared with ALI group. Conclusion Low tidal volume ventilation leads to reduced serum TNF-α, IL-6, IL-8 and MMP-9 not at early stage, but at late stage in LPS-induced ALI rabbit that might be due to an improved PaO2 by low tidal volume ventilation.

关 键 词：脂多糖类 肿瘤坏死因子α 白细胞介素6 白细胞介素8 基质金属蛋白酶9 急性肺损伤 小潮气量机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]