CAJ | 학술논문

目的观察肺牵张反射对急性呼吸窘迫综合征(ARDS)兔肺损伤的影响.方法盐酸吸入法复制兔ARDS模型,应用神经电活动辅助通气(NAVA)进行机械通气,潮气量(VT)维持6 mL/kg,膈肌电活动(EAdi)法选择呼气末正压(PEEP),随机(随机数字法)分为2组:(1)假手术(Sham)组(5只);(2)迷走神经离断(VAG)组(5只).观察在基础状态、ARDS成模、机械通气1,2,3 h时的气体交换及呼吸力学指标.测定肺通透性、病理以及炎症反应指标.结果机械通气2,3 h,VAG组氧合指数(PaO2/FiO2)显著低于Sham组(P＜0.05).在机械通气1,2,3 h时,VAG组二氧化碳分压(PaCO2)与Sham组差异无统计学意义(P＞0.05),VAG组VT、气道峰压(Ppeak)及平均气道压(Pm)均显著高于Sham组(P＜0.05).机械通气3 h,与Sham组相比,VAG组死腔分数(VD/VT)、肺弹性阻力(Ers)明显升高,肺静态顺应性(Cst)明显降低(P＜0.05).与Sham组相比,VAG组肺组织湿/干质量(W/D)、肺损伤评分、肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)、髓过氧化物酶(MPO)及丙二醛(MDA)含最均显著升高(P＜0.05).结论离断迷走神经加重ARDS肺损伤,维持完整肺牵张反射对ARDS具有肺保护作用.
목적 관찰폐견장반사대급성호흡군박종합정(ARDS)토폐손상적영향.방법 염산흡입법복제토ARDS모형,응용신경전활동보조통기(NAVA)진행궤계통기,조기량(VT)유지6 mL/kg,격기전활동(EAdi)법선택호기말정압(PEEP),수궤(수궤수자법)분위2조:(1)가수술(Sham)조(5지);(2)미주신경리단(VAG)조(5지).관찰재기출상태、ARDS성모、궤계통기1,2,3 h시적기체교환급호흡역학지표.측정폐통투성、병리이급염증반응지표.결과 궤계통기2,3 h,VAG조양합지수(PaO2/FiO2)현저저우Sham조(P＜0.05).재궤계통기1,2,3 h시,VAG조이양화탄분압(PaCO2)여Sham조차이무통계학의의(P＞0.05),VAG조VT、기도봉압(Ppeak)급평균기도압(Pm)균현저고우Sham조(P＜0.05).궤계통기3 h,여Sham조상비,VAG조사강분수(VD/VT)、폐탄성조력(Ers)명현승고,폐정태순응성(Cst)명현강저(P＜0.05).여Sham조상비,VAG조폐조직습/간질량(W/D)、폐손상평분、종류배사인자-α(TNF-α)、백개소-8(IL-8)、수과양화물매(MPO)급병이철(MDA)함최균현저승고(P＜0.05).결론 리단미주신경가중ARDS폐손상,유지완정폐견장반사대ARDS구유폐보호작용.
Objective To evaluate the effect of the pulmonary stretch reflex on the lung injury in acute respiratory distress syndrome (ARDS). Method ARDS models of rabbits were induced by intratracheal infusion hydrochloric acid and ventilated with neurally adjusted ventilatory assist (NAVA) with a tidal volume ( VT) of 6 mL/kg and the electrical activity of diaphragm ( Eadi)-determined PEEP level. The rabbits were randomly ( random number) divided into two groups: ( 1 ) sham operation (Sham) group ( n = 5 ),(2) bilateral vagotom (VAG) group( n = 5 ). Gas exchange and pulmonary mechanics were determined at baseline, after lung injury and ventilation 1, 2, 3 h respectively. Indices about pulmonary permeability,pathological changes and inflammatory response were also measured. Results Compared with Sham group,the PaO2/FiO2in VAG group decreased significantly at ventilation 2 h, 3 h (P ＜0.05). There was no significant difference on PaCO2 between Sham and VAG group (P ＞ 0.05 ), and VAG group had the higher VT,peak pressure ( Ppeak), mean pressure (Pm) compared with Sham group at the time point of ventilation 1 h, 2 h, 3 h (P＜0.05). Compared with Sham group, the dead space fraction (VD/VT) and the respiratory system elastance (Ers) in VAG group increased (P ＜ 0.05 ) and the static pulmonary compliance (Cst)decreased markedly (P ＜ 0.05 ) after 3 h ventilation. The wet/dry weight (W/D), lung injury score, tumor necrosis factor-α ( TNF-α), interleukin-8 ( IL-8 ), myeloperoxidase ( M PO ) and malondialdehyde ( M DA )in VAG group elevated significantly when compared with Sham group ( P ＜ 0.05 ). Conclusions The lung injury in ARDS was aggravated after bilateral vagotomy, which demonstrated that the pulmonary stretch reflex may have the lung protective effect.