乌司他丁对家兔油酸型肺损伤后血管外肺水肿及肺换气功能影响.docVIP

乌司他丁对家兔油酸型肺损伤后血管外肺水肿及肺换气功能影响 　 作者:周治明，段开明，罗颖，容雄飞，李勇，夏月峰 【摘要】 目的 研究乌司他丁对家兔油酸型急性肺损伤（ALI）后血管外肺水肿和肺换气功能的影响。方法 随机将20只大白兔分为两组，建立油酸型急性肺损伤模型，Ⅰ组于ALI前10min静脉滴注生理盐水5ml，Ⅱ组于ALI前10min静脉滴注乌司他丁1万u/kg。分别于ALI前后测定兔气道压（Paw）、氧合指数（OI）和呼吸指数（RI）；于ALI后2h取肺组织测定总肺水量（TLW）和肺血管外肺水量（EVLW）。结果 ALI前两组Paw、OI和RI比较，差异无显著性（Pgt;0.05）；ALI后Ⅱ组Paw、OI和RI优于Ⅰ组（Plt;0.05）；ALI后Ⅱ组TLW和EVLW低于Ⅰ组（Plt;0.05）。结论 预防性使用乌司他丁可以减轻兔油酸型急性肺损伤肺水肿，改善肺换气功能。 【关键词】 急性肺损伤；肺水肿；肺功能；乌司他丁 Effects of ulinastain on EVLW and pulmonary gas exchange of rabbits with acute lung injury induced by oleic acid 【Abstract】 Objective To investigate the effects of ulinastain on total lung water content ( TLW)，extravascular lung water content ( EVLW) and pulmonary gas exchange of rabbits with acute lung injury (ALI) induced by oleic acid.Methods Twenty New Zealand white rabbits were divided randomly into two groups.5ml 0.9% NS were injected in Group Ⅰ (n=10) 10 min before the ALI，and ulinastain 10000U/ kg was injected in Group Ⅱ (n=10)at the same time.The pressure of airway （Paw），oxygen index（OI）and respiratory index（RI）were calculated before and after ALI.The TLW and EVLW were measured 2h after ALI.Results There were no significant difference in Paw，OI and RI between the two groups before the ALI（Pgt;0.05）.The Paw，OI and RI in Group Ⅱ were better than those in Group Ⅰ（Plt;0.05）.The TLW and EVLW in Group Ⅱ were lower than those in Group Ⅰ（Plt;0.05）.Conclusion Ulinastain preconditioning can effectively attenuate the pulmonary edema and improve the pulmonary gas exchange of rabbits with ALI induced by oleic acid. 【Key words】 acute lung injury；pulmonary edema；pulmonary function；ulinastain 急性肺损伤（ALI）与中性粒细胞在肺内聚集、激活后释放大量蛋白酶和炎症介质致渗透性肺水肿相关。本实验拟在肺损伤前使用蛋白酶抑制剂乌司他丁，观察其对油酸型肺损伤的作用。 1 材料与方法 1.1 模型建立与分组 健康新西兰大白兔20只，体重2.4～3.0kg，随机分为两组。腹腔内注射硫喷妥钠40mg/kg后于局麻辅助下行气管切开术，静脉注入氯胺酮10mg，维库溴胺1mg后以IPPV行机械通气，潮气量8～10ml/kg，呼吸频率25次/min，吸入氧气浓度维持于35%～45%，以氯胺酮10mg/h、芬太尼10μg/（kg·h）、维库溴胺1mg/h维持麻醉。Ⅰ组中心静脉滴注生理盐水5ml，10min后注入油酸0.08ml/kg（0.071g/kg），建立油酸型ALI模型；Ⅱ组中心静脉滴注乌司他丁1万u/kg，10