肺保护通气策略对慢性阻塞性肺疾病模型呼吸功能和血液动力学的影响  

Effect of Lung Protective Ventilation Strategies on Respiratory Function and Hemodynamics in Chronic Obstructive Pulmonary Disease (COPD) Rats

作　　者：谢翔 王焱[1] 曹东明[1] XIE Xiang;WANG Yan;CAO Dongming(Liaocheng People's Hospital,Shandong Liaocheng 252000,China)

机构地区：[1]山东省聊城市人民医院,山东聊城252000

出　　处：《河北医学》2024年第5期787-793,共7页Hebei Medicine

基　　金：山东省中医药科技项目,(编号:Z-2023033)。

摘　　要：目的:本研究旨在不同潮气量和呼气正末压(PEEP)的肺保护通气策略对慢性阻塞性肺疾病COPD模型大鼠呼吸功能和血液动力学的影响。方法:采用烟熏和气管内滴注脂多糖(LPS)法构建COPD大鼠模型。将大鼠随机分为9组,每组10只:对照组和COPD组仅给予气管插管,不给予机械通气;L+P0组、L+P3组、L+P5组、L+P10组在气管插管后分别给予6mL/kg小潮气量和0cm H_(2)O、3cm H_(2)O、5cm H_(2)O、10cm H_(2)O PEEP的机械通气120min;H+P0组、H+P3组、H+P5组、H+P10组在气管插管后分别给予20mL/kg大潮气量和0cm H_(2)O、3cm H_(2)O、5cm H_(2)O、10cm H_(2)O PEEP的机械通气120min。分别在小动物无创呼吸功能监测系统和血气分析仪中测量呼吸功能和血液动力学指标。采用酶联免疫吸附实验检测肺组织和肺泡灌洗液(BALF)中炎症介质的水平。结果:与对照组相比,COPD组大鼠呼吸功能指标和PaO_(2)均明显降低(P<0.05);与COPD组相比,L+P0组、L+P3组、L+P5组呼吸功能指标和PaO_(2)均明显升高(P<0.05),而L+P10组、H+P0组、H+P3组、H+P5组和H+P10组均明显降低(P<0.05);L+P5组呼吸功能指标和PaO_(2)均明显高于L+P0组和L+P3组(P<0.05);与L+P5组相比,L+P10组、H+P0组、H+P3组、H+P5组和H+P10组呼吸功能指标和PaO_(2)均明显降低(P<0.05)。与对照组相比,COPD组肺组织和BALF中IL-8和TNF-α水平显著升高,而IL-10水平显著降低(P<0.05);与COPD组相比,L+P0组、L+P3组、L+P5组IL-8和TNF-α水平显著降低、IL-10水平显著升高(P<0.05),而L+P10组、H+P0组、H+P3组、H+P5组和H+P10组IL-8和TNF-α水平显著升高、IL-10水平显著降低(P<0.05);L+P5组肺组织中IL-8和TNF-α水平显著低于L+P0组和L+P3组,而IL-10水平显著高于L+P0组和L+P3组(P<0.05);与L+P5组相比,L+P10组、H+P0组、H+P3组、H+P5组和H+P10组IL-8和TNF-α水平显著升高,而IL-10水平显著降低(P<0.05)。结论:小潮气量与较高PEEP(如5cm H_(2)O PEEP)的肺保护通气策略能够减轻COPD大鼠�Objective:To investigate the effects of different tidal volumes and positive end-expiratory pressure(PEEP)lung protective ventilation strategies on respiratory function and hemodynamics in COPD rat models.Methods:COPD rat models were established by smoke inhalation and intratracheal administration of lipopolysaccharide(LPS).Rats were randomly divided into 9 groups(10 rats per group):control and COPD groups received tracheal intubation only without mechanical ventilation;L+P0 group,L+P3 group,L+P5 group,and L+P10 group received mechanical ventilation with 6 ml/kg tidal volume and 0 cm H_(2)O,3 cm H_(2)O,5 cm H_(2)O,and 10 cm H_(2)O PEEP,respectively,for 120 min after tracheal intubation;H+P0 group,H+P3 group,H+P5 group,and H+P10 group received mechanical ventilation with 20 ml/kg tidal volume and 0 cm H_(2)O,3 cm H_(2)O,5 cm H_(2)O,and 10 cm H_(2)O PEEP,respectively,for 120 min after tracheal intubation.Respiratory function and hemodynamic parameters were measured using a small animal non-invasive respiratory function monitoring system and blood gas analyzer.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of inflammatory mediators in lung tissue and bronchoalveolar lavage fluid(BALF).Results:Compared with the control group,COPD rats showed significantly decreased respiratory function parameters and PaO_(2)(P<0.05);compared with the COPD group,L+P0 group,L+P3 group,and L+P5 group showed significantly increased respiratory function parameters and PaO_(2)(P<0.05),while L+P10 group,H+P0 group,H+P3 group,H+P5 group,and H+P10 group showed significantly decreased respiratory function parameters and PaO_(2)(P<0.05);L+P5 group showed significantly higher respiratory function parameters and PaO_(2) than L+P0 group and L+P3 group(P<0.05);compared with L+P5 group,L+P10 group,H+P0 group,H+P3 group,H+P5 group,and H+P10 group showed significantly decreased respiratory function parameters and PaO_(2)(P<0.05).Compared with the control group,COPD rats showed significantly increased levels of IL-8 and TNF-αin

关 键 词：肺保护通气策略 慢性阻塞性肺疾病 呼吸功能 血液动力学 炎症反应 

分 类 号：R563.9[医药卫生—呼吸系统] R-332[医药卫生—内科学]