高剂量高压三氧自体血回输治疗对急性呼吸窘迫综合征犬氧合指数及血清炎症因子水平的影响  

The effect of high dose hyperbaric ozone autologous blood therapy(HOT)on oxygenation index and inflammatory factor level in ARDS dogs

作　　者：杨永涛 陈旭升 王仲睿 李鹏 韩建军 YANG Yongtao;CHEN Xusheng;WANG Zhongrui;LI Peng;HAN Jianjun(Department of Blood Transfusion,the First Affiliated Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院输血科,北京100016

出　　处：《中国输血杂志》2023年第2期101-104,共4页Chinese Journal of Blood Transfusion

基　　金：清华大学精准医学研究院科技攻关自主研发项目(20209990020)。

摘　　要：目的探讨高剂量高压三氧自体血回输治疗(HOT)对急性呼吸窘迫综合征(ARDS)犬氧合指数(PaO_(2)/FiO_(2))及血清炎症因子水平的影响。方法12只健康成年比格犬随机均分为3组(n=4)。空白对照组静脉注入生理盐水;ARDS模型对照组、ARDS三氧治疗组静脉注入油酸(0.12 mL/kg)构建ARDS模型,注入油酸1 h后动脉血气检测结果显示PaO_(2)/FiO_(2)(氧和指数)<300 mmHg即判定模型构建成功,其中ARDS三氧治疗组建模后经左侧股静脉以16 G留置针穿刺并连接三氧治疗仪管路,从犬股静脉负压采集静脉血(50 mL/只)至储血瓶(容量100 mL)后停止采血,打开三氧治疗仪注气开关,向储血瓶注入50 ng/dL三氧气体50 mL,注气结束后将储血瓶上下颠倒3次,使血液充分三氧化后再回输至犬体内;连续往复此治疗10个循环。在治疗前及治疗后1、2、3、4、5 h分别抽取动脉血检测PaO_(2),计算氧合指数(PaO_(2)/FiO_(2))。治疗结束后留存血清,采用ELISA法检测3组实验犬的血清中炎症因子(IL-6、IL-8)和髓过氧化物酶(MPO)的表达。对动物实施安乐死,尸检观察3组实验犬的双肺大体形态,取左肺下叶背段做病理切片HE染色,镜下观察肺组织结构形态改变。结果在治疗5 h后,氧合指数(PaO_(2)/FiO_(2))空白对照组、ARDS模型对照组、ARDS三氧治疗组分别为481.85±35.31、183.67±20.18、271.90±21.35(P<0.01);IL-6(pg/mL)分别为206.49±38.85、293.12±30.38、221.56±46.69(P<0.01),IL-8(pg/mL)分别为207.10±19.82、227.33±57.58、192.72±18.89(P<0.05);MPO(pg/mL)分别为505.58±73.94、605.69±108.88、476.52±103.85(P<0.05)。镜检肺病理切片:ARDS三氧治疗组较ARDS模型对照组犬肺组织的损伤程度明显减轻。结论HOT应用明显提高ARDS模型犬PaO_(2)/FiO_(2),下调MPO的表达,从而抑制中性粒细胞活性,降低炎性因子水平,减轻ARDS模型犬肺脏的炎症和损伤。Objective To investigate the effects of high-dose hyperbaric trioxygen autologous blood therapy(HOT)on oxygenation index(PaO_(2)/FiO_(2))and serum inflammatory factors in dogs with acute respiratory distress syndrome(ARDS).Methods Twelve healthy adult beagles were randomly divided into 3 groups(n=4).The blank group was injected with normal saline intravenously.The ARDS model was established by intravenous injection of oleic acid(0.12 mL/kg)in the ARDS group and ARDS+HOT group.The mark of a successful model is that the oxygen and index(PaO_(2)/FiO_(2))<300 mmHg.In the ARDS+HOT group,after the ARDS model was established,16 G indwelling needle was used to puncture the left femoral vein and connect the line of the HOT device.Venous blood(50 mL/dog)was collected from the femoral vein under negative pressure to the blood storage bottle(100 mL blood storage bottle),and then the blood collection was stopped and the gas injection switch of the HOT device was turned on.Inject 50 mL of 20ng/dL trioxygen gas into the blood storage bottle.After gas injection,turn the blood storage bottle upside down three times to fully trioxidize the blood and then inject it back into the dog.Repeat this treatment for 10 cycles.PaO_(2)and PaO_(2)/FiO_(2)were detected before treatment and at 1,2,3,4,5 h after treatment.The serum was retained after treatment,and the expressions of inflammatory cytokines(IL-6,IL-8)and myeloperoxidase(MPO)were detected by ELISA.The animals were euthanized,and the gross lung morphology of the dogs was observed at autopsy.The dorsal segment of the left lower lobe of the lung was taken for pathological section HE staining,and the morphological changes of the lung tissue were observed under the microscope.Results After 5 hours of treatment,the PaO_(2)/FiO_(2)of blank group was 481.85±35.31,and that of ARDS group was 183.67±20.18,which was significantly lower than that of blank group(P<0.01).The ARDS HOT group was 271.90±21.35,which was significantly higher than the ARDS group(P<0.01).The inflammatory factor IL-6

关 键 词：三氧疗法 自体输血 急性呼吸窘迫综合征 氧合指数 炎症因子 动物实验 

分 类 号：R459.6[医药卫生—治疗学] R457.1[医药卫生—临床医学] R563.8