七氟醚复合硬膜外阻滞对兔急性缺氧时肺组织超微结构和肺泡表面活性物质的影响.docVIP

七氟醚复合硬膜外阻滞对兔急性缺氧时肺组织超微结构和肺泡表面活性物质的影响 王丽珺 仓静* 薛张纲 【摘要】目的 观察七氟醚复合硬膜外阻滞对兔缺氧时肺组织超微结构和肺泡表面活性物质的影响。方法 健康新西兰大白兔28只，平均每只体质量大于2kg。随机分为4组（n=7）：对照组（C组）、缺氧组（H组）、七氟醚组（S组）和硬膜外复合七氟醚组（ES组）。ES组硬膜外导管首剂注入1%利多卡因3mg/kg，此后每小时追加该剂量。麻醉后气管插管，机械通气。H组、S组和ES组吸入14%的氮氧混合气体，直至PaO2/FiO2＜300，急性肺损伤（ALI）模型建立。3h后恢复自主呼吸，吸入21％的氧气，并于自主呼吸（T0）,模型建立后15min、30min、1h、2h、3h和恢复自主呼吸后（T1-6）测PaO2。C组始终吸21％的氧气，并于相应时点测PaO2。实验结束后立即处死动物，开胸取肺。进行支气管肺泡灌洗，取肺泡灌洗液离心后上清夜-70℃保存，以测总磷脂(TPL)、饱和卵磷脂(DSPC)及总蛋白(TP)含量，肺组织分别送光镜和电镜检测。结果 H组、S组和ES组均于缺氧15min后建立ALI模型。H组、S组和ES组的SatPC/TPL及SatPC/TP显著降低（P0.05）。S组的SatPC/TP低于H组及ES组、SatPC/TPL低于ES组（P0.05）。与ES组相比，H组和S组肺泡II型上皮细胞肿胀明显，板层体减少，并呈大量空泡化。结论 七氟醚通过影响肺泡II型上皮细胞板层小体，使急性缺氧性肺损伤时肺泡表面活性物质减少，复合硬膜外阻滞能在一定程度上改善肺组织超微结构的破坏。 【关键词】麻醉，硬膜外； 七氟醚； 肺泡表面活性物质 Effects of combined sevoflurane-thoracic epidural anesthesia on ultrastrocture of the lung and pulmonary surfactant during acute hypoxia in rabbits WANG Lijun, CANG Jin, Xue Zhanggang*. Department of Anesthesiology, Zhongshan Hospital, Medical Center of Fudan University, Shanghai 200032 [Abstract] Objective To evaluate the effects of combined sevoflurane-thoracic epidural anesthesia on ultrastrocture of the lung and pulmonary surfactant during acute hypoxia in rabbits. Methods Twenty-eight New Zealand white rabbits of either sex, weighing above 2kg were randomly divided into 4 groups with 7 animals in each group:control group(Group C), hypoxia group(Group G), sevoflurane group(Group S)and combined sevoflurane-epidural anesthesia group(Group ES). In Group ES, The catheter was inserted at T5 ,6 interspace and advanced 1 cm into the epidural space cephalad. 1% lidocaine was injected after the epidural block was confirmed by epidurography ,followed by injection the same dose every one hour. The rabbits were anesthetized with 30mg/kg pentobarbital by IV infusion and tracheotomized and intubated，then they were mechanically ventilated( Group H, S and ES: FiO2 =14% , Group C: FiO2 =21%, VT= 10～1 ml/kg , RR = 25bpm ,I∶E = 1∶2) . The acute lung injure (ALI)models