中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
17期
1998-2002
,共5页
兰超%李海娜%李莉%王金柱%李璐%刘兰萍%狄敏
蘭超%李海娜%李莉%王金柱%李璐%劉蘭萍%狄敏
란초%리해나%리리%왕금주%리로%류란평%적민
百草枯%急性肺损伤%甲泼尼龙%氨溴索%心排血量
百草枯%急性肺損傷%甲潑尼龍%氨溴索%心排血量
백초고%급성폐손상%갑발니룡%안추색%심배혈량
Paraquat%Acute lung injury%Methylprednisolone%Ambroxol%Cardiac output
目的:探讨甲泼尼龙联合氨溴索对急性百草枯中毒家猪急性肺损伤(ALI)的影响。方法用20%百草枯原液20 ml 腹腔注射制备家猪急性百草枯中毒后 ALI/急性呼吸窘迫综合征(ARDS)模型,实验过程中始终连接呼吸机辅助呼吸,造模成功后随机分为 A、B、C 组,A 组为百草枯染毒甲泼尼龙干预组(6只),B 组为百草枯染毒氨溴索干预组(6只),C 组为百草枯染毒甲泼尼龙联合氨溴索干预组(6只)。3组均在常规补液基础上给予药物干预,采用脉搏指示连续心排血量(PICCO)监测造模前、造模成功(t0)及药物干预后12 h(t12)、24 h(t24)及36 h(t36)时的心率(HR)、平均动脉压(MAP)、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)、动脉血 pH 值、氧分压(PaO2),计算氧合指数(PaO2/ FiO2)。3组在造模前、t0、t12、t24、t36时分别行肺组织穿刺,通过 Western blot 方法检测肺组织中肺表面活性物质蛋白- D(SP - D)水平,采用苏木精-伊红(HE)染色法观察造模前、t0及 t36时肺组织的病理变化。结果(1)PaO2/ FiO2比较:t0时3组均较造模前降低,t12时均较 t0时升高,t24、t36时较 t12时均降低(P ﹤0.05)。(2)SP - D 水平比较:t0时3组均较造模前降低,t12时均较 t0时升高,t24、t36时较 t12时降低(P ﹤0.05)。(3)EVLWI 和 PVPI 比较:组间比较,3组造模前及 t0时差异无统计学意义(P ﹥0.05),t12、t24、t36时差异均有统计学意义(P ﹤0.05)。组内比较,t0时3组 EVLWI 和 PVPI 均较造模前上升( P ﹤0.05);造模成功后,3组EVLWI在 t12、t24和 t36时与组内 t0时比较,差异均有统计学意义(P ﹤0.05);t12、t24、t36时3组 PVPI 与组内 t0时比较,差异均无统计学意义(P ﹥0.05)。(4)造模成功后肺组织呈明显损伤性改变,药物治疗36 h 后,以 C 组家猪肺组织的病理损伤最轻。结论与单用甲泼尼龙或者氨溴索相比,甲泼尼龙联合氨溴索减轻百草枯中毒家猪 ALI 的效果更明显,可以更好地改善氧合状况,促进 SP - D 的合成,减轻百草枯中毒家猪的肺损伤。
目的:探討甲潑尼龍聯閤氨溴索對急性百草枯中毒傢豬急性肺損傷(ALI)的影響。方法用20%百草枯原液20 ml 腹腔註射製備傢豬急性百草枯中毒後 ALI/急性呼吸窘迫綜閤徵(ARDS)模型,實驗過程中始終連接呼吸機輔助呼吸,造模成功後隨機分為 A、B、C 組,A 組為百草枯染毒甲潑尼龍榦預組(6隻),B 組為百草枯染毒氨溴索榦預組(6隻),C 組為百草枯染毒甲潑尼龍聯閤氨溴索榦預組(6隻)。3組均在常規補液基礎上給予藥物榦預,採用脈搏指示連續心排血量(PICCO)鑑測造模前、造模成功(t0)及藥物榦預後12 h(t12)、24 h(t24)及36 h(t36)時的心率(HR)、平均動脈壓(MAP)、血管外肺水指數(EVLWI)、肺血管通透性指數(PVPI)、動脈血 pH 值、氧分壓(PaO2),計算氧閤指數(PaO2/ FiO2)。3組在造模前、t0、t12、t24、t36時分彆行肺組織穿刺,通過 Western blot 方法檢測肺組織中肺錶麵活性物質蛋白- D(SP - D)水平,採用囌木精-伊紅(HE)染色法觀察造模前、t0及 t36時肺組織的病理變化。結果(1)PaO2/ FiO2比較:t0時3組均較造模前降低,t12時均較 t0時升高,t24、t36時較 t12時均降低(P ﹤0.05)。(2)SP - D 水平比較:t0時3組均較造模前降低,t12時均較 t0時升高,t24、t36時較 t12時降低(P ﹤0.05)。(3)EVLWI 和 PVPI 比較:組間比較,3組造模前及 t0時差異無統計學意義(P ﹥0.05),t12、t24、t36時差異均有統計學意義(P ﹤0.05)。組內比較,t0時3組 EVLWI 和 PVPI 均較造模前上升( P ﹤0.05);造模成功後,3組EVLWI在 t12、t24和 t36時與組內 t0時比較,差異均有統計學意義(P ﹤0.05);t12、t24、t36時3組 PVPI 與組內 t0時比較,差異均無統計學意義(P ﹥0.05)。(4)造模成功後肺組織呈明顯損傷性改變,藥物治療36 h 後,以 C 組傢豬肺組織的病理損傷最輕。結論與單用甲潑尼龍或者氨溴索相比,甲潑尼龍聯閤氨溴索減輕百草枯中毒傢豬 ALI 的效果更明顯,可以更好地改善氧閤狀況,促進 SP - D 的閤成,減輕百草枯中毒傢豬的肺損傷。
목적:탐토갑발니룡연합안추색대급성백초고중독가저급성폐손상(ALI)적영향。방법용20%백초고원액20 ml 복강주사제비가저급성백초고중독후 ALI/급성호흡군박종합정(ARDS)모형,실험과정중시종련접호흡궤보조호흡,조모성공후수궤분위 A、B、C 조,A 조위백초고염독갑발니룡간예조(6지),B 조위백초고염독안추색간예조(6지),C 조위백초고염독갑발니룡연합안추색간예조(6지)。3조균재상규보액기출상급여약물간예,채용맥박지시련속심배혈량(PICCO)감측조모전、조모성공(t0)급약물간예후12 h(t12)、24 h(t24)급36 h(t36)시적심솔(HR)、평균동맥압(MAP)、혈관외폐수지수(EVLWI)、폐혈관통투성지수(PVPI)、동맥혈 pH 치、양분압(PaO2),계산양합지수(PaO2/ FiO2)。3조재조모전、t0、t12、t24、t36시분별행폐조직천자,통과 Western blot 방법검측폐조직중폐표면활성물질단백- D(SP - D)수평,채용소목정-이홍(HE)염색법관찰조모전、t0급 t36시폐조직적병리변화。결과(1)PaO2/ FiO2비교:t0시3조균교조모전강저,t12시균교 t0시승고,t24、t36시교 t12시균강저(P ﹤0.05)。(2)SP - D 수평비교:t0시3조균교조모전강저,t12시균교 t0시승고,t24、t36시교 t12시강저(P ﹤0.05)。(3)EVLWI 화 PVPI 비교:조간비교,3조조모전급 t0시차이무통계학의의(P ﹥0.05),t12、t24、t36시차이균유통계학의의(P ﹤0.05)。조내비교,t0시3조 EVLWI 화 PVPI 균교조모전상승( P ﹤0.05);조모성공후,3조EVLWI재 t12、t24화 t36시여조내 t0시비교,차이균유통계학의의(P ﹤0.05);t12、t24、t36시3조 PVPI 여조내 t0시비교,차이균무통계학의의(P ﹥0.05)。(4)조모성공후폐조직정명현손상성개변,약물치료36 h 후,이 C 조가저폐조직적병리손상최경。결론여단용갑발니룡혹자안추색상비,갑발니룡연합안추색감경백초고중독가저 ALI 적효과경명현,가이경호지개선양합상황,촉진 SP - D 적합성,감경백초고중독가저적폐손상。
Objective To study the impacts of methylprednisolone combined with ambroxol hydrochloride on acute lung injury(ALI)in swine with paraquat(PQ)intoxication. Methods Swine were prepared to establish acute lung injury/ a-cute respiratory distress syndrome(ALI/ ARDS)models by intraperitoneal injection of 20% PQ solution(20 millilitres)and di-vided randomly into groups A(intervened with methylprednisolone),B( intervened with ambroxol hydrochloride),C( inter-vened with methylprednisolone combined with ambroxol hydrochloride),6 in each. Heart rates(HR),mean arterial pressure (MAP),extravascular lung water index(EVLWI),pulmonary vascular permeability index(PVPI),arterial pH,partial pres-sure of oxygen(PaO2 )were monitored by pulse - indicated continuous cardiac output(PICCO)before and after modeling,at hours 12(t12 ),24(t24 ),36(t36 )after intervention. Oxygenation index(PaO2 / FiO2 ) was calculated. At t36 ,swine were executed,lung tissue biopsy performed before modeling,at t0 ,t12 ,t24 ,t36 . Pulmonary surfactant protein - E(SP - D)was detected by Western blot method,the pathological changes of pulmonary tissues observed by Hemotoxylin - Eosin(HE)staining before modeling,at t0 ,t36 . Results PaO2 / FiO2 was lower at t0 than before modeling,higher at t12 than at t0 ,lower at t24 ,t36 than at t12 in 3 groups(P ﹤ 0. 05). SP - D level was lower at t0 ,higher at t12 than before modeling,lower at t24 ,t36 than at t12 (P ﹤ 0. 05). There was no significant difference in EVLWI,PVPI between 3 groups before modeling,at t0 (P ﹥ 0. 05),there was at t12 ,t24 ,t36 (P ﹤ 0. 05). EVLWI was higher at t0 than before modeling in 3 groups(P ﹤ 0. 05),and decreased at t12 , increased at t24 ,t36 ,differing from those at t0 (P ﹤ 0. 05). PVPI increased at t12 ,t24 ,t36 ,not differing from that at t0 (P ﹥0. 05). After successful modeling,damages appeared in lung tissues. The pathological damages were the lightest in group C af-ter 36h of treatment. Conclusion The effect of methylprednisolone combined with ambroxol hydrochloride is more remarkable in treatment of swine with PQ - led ALI as compared with simple methylprednisolone or ambroxol hydrochloride. It can improve oxy-genation better,promote SP - D synthesis,reduce the lung injury in PQ swine.