不同负压对兔气道黏液高分泌模型的吸痰效果及气道损伤程度  

The effect and injury to the airways of different sputum aspiration pressure in a rat model of mucus hypersecretion

作　　者：王锐霞[1,2] 沈皆亮[1] 刘代顺[1] 李春鸣[3] 

机构地区：[1]遵义医学院第三附属医院护理部,563002 [2]贵州医科大学附属医院护理部 [3]遵义医学院病理教研室

出　　处：《中华结核和呼吸杂志》2016年第7期534-538,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的：探讨适宜的吸痰负压强度，确保临床吸痰操作的有效性与安全性。方法4月龄清洁级新西兰大白兔30只，采用丙烯醛雾化吸入建立兔气道黏液高分泌模型，建模成功后采用随机数字表法分为4组，分别给予不同强度的负压吸痰：A组－75 mmHg（1 mmHg＝0.133 kPa），B组－150 mmHg，C组－225 mmHg，D组－300 mmHg。记录吸痰量、脉搏血氧饱和度（ SpO2）、气道分泌物中白细胞介素－1β（ IL－1β）和肿瘤坏死因子－α（ TNF－α）以及气管黏膜病理切片，评价吸痰效果及气道损伤情况。结果4组吸痰量分别为（2.72±0.24）、（4.81±0.32）、（5.03±0.37）和（6.29±0.51） ml， D组显著高于其他3组，A组则低于其他3组，差异有统计学意义（P＜0.05），B、C两组比较无明显差异；四组吸痰负压后SpO2均有所降低，其中C、D组SpO2下降的最大值分别为（18.1±5.2）％和（32.4±8.4）％，明显高于A、B组[（4.4±1.7）％和（6.4±2.9）％）]，A、B组间比较差异无统计学意义，其余各组比较差异均有统计学意义（均P＜0.05）。气管黏膜HE染色及分泌物中的IL－1β和TNF－α分析提示C、D组的炎性细胞浸润及黏膜损伤程度比A、B两组更为严重，A组气道黏膜损伤最轻。结论－150 mmHg吸痰负压具有吸痰效率较高、对呼吸动力学和气道损伤影响较小的优势，可为临床研究提供适宜的吸痰负压强度提供参考。Objective To explore the optimal pressure of sputum aspiration to ensure the effectiveness and safety of clinical operation .Methods We established a rabbit model of airway mucus hypersecretion by aerosol acrolein inhalation , and the animals were divided into 4 groups randomly with different sputum aspiration pressure as follows： group A -75 mmHg （ 1 mmHg=0.133 kPa ） , group B-150 mmHg, group C -225 mmHg, group D -300 mmHg.Sputum aspiration efficiency and tracheal mucosal damage degree were evaluated by sputum volume , oxygen saturation changes , the pathological sections of tracheal mucosa and the expressions of IL-1βand TNF-αin airway secretion.Results The sputum suction volume of group A , B, C, D were （ 2.72 ±0.24 ） , （ 4.81 ±0.32 ） , （ 5.03 ±0.37 ） and （6.29 ±0.51 ） ml, respectively, which was significantly higher in group D , but lower in group A, as compared to other groups （ P〈0.05 ） .There were no significant differences between B and C groups . The maximal SpO 2 decrease of C and D groups [ （ 18.1 ±5.2 ）% and （ 32.4 ±8.4 ）%] were significantly higher than those in A and B groups [（4.4 ±1.7）%and （6.3 ±2.9）%], and group D was significantly more than group C , and the difference was statistically significant （ P〈0.05 ） .There were no significant differences between A and B groups . HE staining of tracheal mucosa in C and D groups showed that the inflammatory cell infiltration and mucosal damage were more serious than A and B groups , but the airway mucosal damage of group A was the least .Conclusion The pressure of -150 mmHg was more effective with high oxygen saturation and less airway injury , which may be suitable for clinical sputum aspiration.

关 键 词：吸痰 负压强度 气道损伤 血氧饱和度 

分 类 号：R56[医药卫生—呼吸系统]