CAJ | 학술논문

目的：探讨俯卧位通气对腹腔注射脂多糖（LPS）诱导的肺外源性急性肺损伤（ALI）的治疗作用及其机制。方法将32只雄性SD大鼠按随机数字表法分为对照组、ALI组、ALI仰卧位通气组（ALIS组）及ALI俯卧位通气组（ALIP组）。采用腹腔注射LPS 6 mg/kg复制ALI动物模型，对照组腹腔注射生理盐水2 mL/kg；24 h后，ALIS组及ALIP组分别采取仰卧位或俯卧位通气4 h。观察动物动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、肺湿/干质量（W/D）比值；收集支气管肺泡灌洗液（BALF）并测定上清液中肿瘤坏死因子-α（TNF-α）、白细胞介素（IL-6、IL-10）水平；光镜下观察肺组织病理形态学的变化。结果与对照组比较，ALI组、ALIS组、ALIP组PaO2均明显降低〔mmHg（1mmHg＝0.133kPa）：68±7、82±8、93±7比116±7〕，ALI组、ALIS组PaCO2均明显升高（mmHg：53±6、51±5比43±7，均P＜0.05）；ALI组、ALIS组、ALIP组肺W/D比值及BALF中TNF-α、IL-6、IL-10均明显升高〔肺W/D比值：5.11±0.32、4.71±0.38、4.53±0.45比4.48±0.15，TNF-α（ng/L）：548±82、431±64、347±53比162±16，IL-6（ng/L）：772±119、587±178、490±139比127±16，IL-10（ng/L）：211±43、295±36、352±59比104±31，均P＜0.05〕；与ALI组比较，ALIS组和ALIP组PaO2明显升高，ALIP组PaCO2降低，肺W/D比值及BALF中TNF-α、IL-6明显降低，IL-10明显升高（均P＜0.05），且以ALIP组变化更显著（均P＜0.05）。光镜下显示，与ALIS组比较， ALIP组腹侧过度膨胀区域减少，正常及塌陷区域增加，背侧塌陷区域减少，正常通气区域增加（均P＜0.05）。结论在LPS诱导的肺外源性ALI大鼠模型中，俯卧位通气可以改善气体交换，促进气体均匀分布，减轻肺水肿，同时降低炎症反应。
목적：탐토부와위통기대복강주사지다당（LPS）유도적폐외원성급성폐손상（ALI）적치료작용급기궤제。방법장32지웅성SD대서안수궤수자표법분위대조조、ALI조、ALI앙와위통기조（ALIS조）급ALI부와위통기조（ALIP조）。채용복강주사LPS 6 mg/kg복제ALI동물모형，대조조복강주사생리염수2 mL/kg；24 h후，ALIS조급ALIP조분별채취앙와위혹부와위통기4 h。관찰동물동맥혈양분압（PaO2）、이양화탄분압（PaCO2）、폐습/간질량（W/D）비치；수집지기관폐포관세액（BALF）병측정상청액중종류배사인자-α（TNF-α）、백세포개소（IL-6、IL-10）수평；광경하관찰폐조직병리형태학적변화。결과여대조조비교，ALI조、ALIS조、ALIP조PaO2균명현강저〔mmHg（1mmHg＝0.133kPa）：68±7、82±8、93±7비116±7〕，ALI조、ALIS조PaCO2균명현승고（mmHg：53±6、51±5비43±7，균P＜0.05）；ALI조、ALIS조、ALIP조폐W/D비치급BALF중TNF-α、IL-6、IL-10균명현승고〔폐W/D비치：5.11±0.32、4.71±0.38、4.53±0.45비4.48±0.15，TNF-α（ng/L）：548±82、431±64、347±53비162±16，IL-6（ng/L）：772±119、587±178、490±139비127±16，IL-10（ng/L）：211±43、295±36、352±59비104±31，균P＜0.05〕；여ALI조비교，ALIS조화ALIP조PaO2명현승고，ALIP조PaCO2강저，폐W/D비치급BALF중TNF-α、IL-6명현강저，IL-10명현승고（균P＜0.05），차이ALIP조변화경현저（균P＜0.05）。광경하현시，여ALIS조비교， ALIP조복측과도팽창구역감소，정상급탑함구역증가，배측탑함구역감소，정상통기구역증가（균P＜0.05）。결론재LPS유도적폐외원성ALI대서모형중，부와위통기가이개선기체교환，촉진기체균균분포，감경폐수종，동시강저염증반응。
Objective To investigate the effects and mechanism of prone ventilation in rats with lipopolysaccharide(LPS)-induced extra pulmonary acute lung injury(ALI). Methods Thirty-two male Sprague-Dawley(SD)rats were randomly divided into four groups:control group,ALI group,supine position group(ALIS group)and prone position group(ALIP group). The ALI animal model was reproduced by intra-peritoneal injection of LPS 6 mg/kg,and 2 mL/kg sterile saline was intra-peritoneally injected in control group. After 24 hours,the ALIS group and ALIP group were mechanically ventilated for 4 hours in supine and prone positions respectively. Arterial partial pressure of oxygen(PaO2),carbon dioxide partial pressure(PaCO2),wet to dry weight ratio of lung(W/D) were observed,and the levels of tumor necrosis factor-α(TNF-α),interleukins(IL-6,IL-10)in bronchoalveolar lavage fluid(BALF)were measured. The degrees of histopathological changes of lung were investigated and assessed under light microscope. Results Compared with control group,PaO2 was significantly lower in ALI,ALIS and ALIP groups〔mmHg(1 mmHg=0.133 kPa):68±7,82±8,93±7 vs. 116±7〕,and the PaCO2 in ALI and ALIS groups was obviously higher(mmHg:53±6,51±5 vs. 43±7,both P<0.05);lung W/D ratio as well as levels of TNF-α, IL-6 and IL-10 in BALF were significantly higher in ALI,ALIS and ALIP groups〔lung W/D ratio:5.11±0.32, 4.71±0.38,4.53±0.45 vs. 4.48±0.15,TNF-α(ng/L):548±82,431±64,347±53 vs. 162±16,IL-6(ng/L):772±119,587±178,490±139 vs. 127±16,IL-10(ng/L):211±43,295±36,352±59 vs. 104±31,all P<0.05〕. Compared with ALI group,PaO2 in ALIS and ALIP groups was significantly higher,and in ALIP group,PaCO2 was lower,lung W/D ratio,TNF-α and IL-6 in BALF were obviously lower,while IL-10 in BALF was obviously higher(all P<0.05). Compared with ALIS group,the changes in ALIP group were more significant(all P<0.05). Compared with ALIS group,under light microscope,it was shown that the hyper-inflated areas were less,normal and collapsed areas were greater on the ventral side,and the collapsed area was less and the normal ventilation area was greater on the dorsal side in ALIP group(all P<0.05). Conclusion In rats with LPS-induced extra pulmonary ALI,the prone ventilation can improve gas exchange,promote uniform distribution of ventilation,decrease pulmonary edema and in the mean time attenuate inflammatory response.