肺保护性通气策略对烟雾吸入性损伤犬氧合和肺组织炎症反应的影响  

Effect of lung protective ventilation strategy on oxygenation and pulmonary inflammatory response in dogs with severe smoke inhalation injury

作　　者：廖新成[1] 郭光华[1] 王年云[1] 

机构地区：[1]南昌大学第一附属医院烧伤科,江西南昌330006

出　　处：《中国中西医结合急救杂志》2015年第5期453-457,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金资助项目（30960400）;江西省高等学校博士学科点专项科研基金（20093601110005）;江西省科技支撑计划（2010BSA10300）

摘　　要：目的 探讨肺保护性通气策略对烟雾吸入性损伤犬氧合及肺组织炎症反应的影响.方法 选择本地健康雄性犬12只,采用控烟、控时烟雾吸入损伤致伤仪复制重度烟雾吸入性损伤犬模型,按随机数字表法将动物分为常规通气组（CV组）和保护性通气组（PV组）,均通气治疗8 h.于伤前、致伤及通气2、4、6、8 h行动脉血气分析,采用酶联免疫吸附试验（ELISA）检测血清肿瘤坏死因子-α（TNF-α）、白细胞介素-10 （IL-10）的含量;通气治疗8 h后处死动物,取肺组织观察其病理学变化及肺损伤程度评分,并检测肺组织匀浆中TNF-α、IL-10含量.结果 CV组和PV组致伤后动脉血氧分压（PaO2）水平均较伤前显著降低〔mmHg （1 mmHg=0.133 kPa）：57±19比128±31,58±15比126±22,均P〈0.01〕,两组伤后pH值和动脉血二氧化碳分压（PaCO2）与伤前比较差异均无统计学意义（均P〉0.05）;通气治疗6 h PV组PaO2水平显著高于同期CV组（mmHg：121±11比105±11,P〈0.05）;两组通气治疗2、4、8 h PaO2水平及各时间点pH值和PaCO2水平比较差异均无统计学意义（均P〉0.05）.PV组肺泡腔组织水肿及炎性细胞浸润程度较明显CV组减轻,CV组肺组织损伤评分显著高于PV组（分：3.68±0.22比3.27±0.35,P〈0.05）.CV组和PV组致伤后血清中炎症因子TNF-α、IL-10含量均较伤前显著升高〔TNF-α（μg/L）：4.32±1.13比0.35±0.11,4.51±2.02比0.41±0.08;IL-10（ng/L）：16.73±2.31比4.27±0.56,18.39±3.15比4.03±1.07,均P〈0.01〕;与CV组比较,PV组通气治疗6 h和8 h血清TNF-α含量显著下降〔6 h（μg/L）：2.62±0.34比3.65±1.08,8 h（μg/L）：3.02±0.31比4.21±1.27,均P〈0.05〕,IL-10显著增加〔6 h（ng/L）：21.07±2.95比16.11±3.02,8 h（ng/L）：23.57±2.69比18.28±3.21,均P〈0.05〕;CV组肺组织匀浆中TNF-α含量高于PV组（μg/L：5.85±2.57比3.08±1.17,P〈0.05）,IL-10明显低于PV组（ng/L：19.64±3.16比24.05±2.09,P〈0.05）.结�Objective To observe the effect of lung protective ventilation strategy on oxygenation and pulmonary inflammatory response in dogs with severe smoke inhalation injury.Methods Twelve local healthy male dogs were selected and anesthetized underwent endotracheal intubation, the time controlled smoke was applied to replicate the model of severe smoke inhalation injury, and they were divided into two groups according to the random number table： conventional ventilation group （CV group） and protective ventilation group （PV group）, each receiving corresponding ventilation mode for 8 hours respectively. The blood gas analyses were detected before injury, immediately after injury and at ventilation for 2, 4, 6, 8 hours. The contents of tumor necrosis factor-α （TNF-α）, interleukin-10 （IL-10） in serum were detected by the enzyme-linked immunosorbent assay （ELISA） at each time point. Animals were killed after 8-hour ventilation, and different parts of the lung tissues were obtained for pathological examinations of lung tissues and evaluation of injury scores. The levels of inflammatory factors as TNF-α and IL-10 in lung homogenates were measured by ELISA.Results The arterial partial pressure （PaO2） levels in CV and PV groups were significantly decreased after injury compared with those before injury [mmHg （1 mmHg = 0.133 kPa）： 57±19 vs. 128±31, 58±15 vs. 126±22, bothP 〈 0.01]. Compared with those before injury, the pH values and arterial carbon dioxide partial pressure （PaCO2） levels after injury in two groups had no statistically significant differences at each time point （bothP 〉 0.05）. At 6 hours ventilation, PaO2 level in PV group was significantly higher than that in CV group （mmHg： 121±11 vs. 105±11,P 〈 0.05）. The comparisons of PaO2 levels, pH values and PaCO2 levels at 2, 4, 8 hours of ventilation between the two groups showed no statistically significant differences （allP 〉 0.05）. The histopathological changes revealed that there were alveolar tissue

关 键 词：肺保护性通气策略 吸入性损伤 犬 炎症反应 

分 类 号：R563.805[医药卫生—呼吸系统]