CAJ | 학술논문

目的探讨不同潮气量（ TV）机械通气对大白兔肺组织TNF-α和CC16的影响。方法将30只健康雄性大白兔按随机数字表随机分成对照组、小潮气量组及大潮气量组，每组10只。对照组插管后不进行机械通气，其他组插管后机械通气，小潮气量组TV 8 ml/kg，大潮气量组TV 25 ml/kg，其他参数相同。通气时间24 h。观察实验前后动脉血氧分压变化、ELISA法测定肺组织TNF-α及CC16、测定肺组织湿/干重（ W/D）值、制备肺组织石蜡切片，在显微镜下观察肺组织病理学变化。结果与对照组比较，大潮气量组实验结束动脉氧分压降低（P＜0．05），肺组织W/D、TNF-α升高，CC16降低（P＜0．01），小潮气量组相应指标无显著变化（P＞0．05）。大潮气量组肺组织病理切片可见肺组织水肿。结论大潮气量机械通气发生了呼吸机相关性肺损伤（ VILI），表现为动脉氧分压、肺组织W/D、TNF-α、肺组织病理切片的变化，而同时肺组织CC16下降，表明CC16可能在VILI发病机制中起重要作用。
목적탐토불동조기량（ TV）궤계통기대대백토폐조직TNF-α화CC16적영향。방법장30지건강웅성대백토안수궤수자표수궤분성대조조、소조기량조급대조기량조，매조10지。대조조삽관후불진행궤계통기，기타조삽관후궤계통기，소조기량조TV 8 ml/kg，대조기량조TV 25 ml/kg，기타삼수상동。통기시간24 h。관찰실험전후동맥혈양분압변화、ELISA법측정폐조직TNF-α급CC16、측정폐조직습/간중（ W/D）치、제비폐조직석사절편，재현미경하관찰폐조직병이학변화。결과여대조조비교，대조기량조실험결속동맥양분압강저（P＜0．05），폐조직W/D、TNF-α승고，CC16강저（P＜0．01），소조기량조상응지표무현저변화（P＞0．05）。대조기량조폐조직병리절편가견폐조직수종。결론대조기량궤계통기발생료호흡궤상관성폐손상（ VILI），표현위동맥양분압、폐조직W/D、TNF-α、폐조직병리절편적변화，이동시폐조직CC16하강，표명CC16가능재VILI발병궤제중기중요작용。
Objective To explore the effects of mechanical ventilation at different tidal volumes on the ex-pression of TNF-αand Clara cell secretory 16-kD protein ( CC16 ) in the lung of rabbits .Methods Thirty healthy male rabbits were randomly divided into three groups ,control group,low tidal volume group ( L-TV group) and high tidal volume group ( H-TV group ) ,10 rabbits in each group .Mechanical ventilation was performed in all the groups after intubation except for control group , tidal volume was 8ml/kg in the L-TV group while 25ml/kg in the H-TV group,and other parameters in the three groups were the same .Mechanical ventilation lasted for 24 hours.Changes of arterial partial pressure of oxygen before and after experiment were observed .The levels of TNF-αand ( CC16 ) in the lung tissues were detected by ELISA,and the wet-to-dry weight(W/D) ratio of lung tissues was calculated.Lung tis-sue sections were prepared for biopsies ,and the histopathologic changes in the lung tissues were observed with micro-scope .Results The arterial partial pressure of oxygen decreased in the H-TV group compared with control group ( P<0.05),the W/D ratio and TNF-αlevel increased in the lung tissues while CC16 level decreased(P<0.01),the corresponding indices showed no significant changes in the L-TV group(P>0.05) .Lung tissue edema could be ob-served in the H-TV group with lung tissue biopsy .Conclusion High tidal volume mechanical ventilation produces ventilator-induced lung injury ( VILI) ,which present the change of arterial partial pressure of oxygen ,lung tissue W/D,TNF-α,and biopsy of lung pathology .CC16 in the lung tissues decreases at the same time , which indicates that CC16 may play an important role in the occurrence and development of VILI .