甲泼尼龙治疗急性百草枯中毒家猪肺损伤的剂量观察
갑발니룡치료급성백초고중독가저폐손상적제량관찰
Observation on the best dose of methylprednisolone improving lung injury in swine with paraquat intoxication
  • 万方数据
    中华劳动卫生职业病杂志 중화노동위생직업병잡지
    CHINESE JOURNAL OF INDUSTRIAL HYGIENE AND OCCUPATIONAL DISEASES
    2015年 1期 24-28 ,共5页

    兰超%李海娜%李莉%王金柱%裴辉%李璐%刘兰萍%狄敏

    란초%리해나%리리%왕금주%배휘%리로%류란평%적민

    百草枯%急性肺损伤%甲泼尼龙 百草枯%急性肺損傷%甲潑尼龍
    백초고%급성폐손상%갑발니룡
    Paraquat%Acute lung injury%Methylprednisolone
    目的 观察甲泼尼龙治疗急性百草枯(PQ)中毒家猪肺损伤的最佳剂量.方法 取20 ml含20％PQ原液对家猪进行腹腔注射,制备急性PQ中毒家猪急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)模型,将造模成功的家猪模型随机分为PQ染毒对照组,5、15、30 mg/kg甲泼尼龙组.4组家猪模型均在常规补液基础上给予干预,采用脉搏指示连续心排血量(PICCO)监测造模前、造模成功时(t0)、不同处理之后12 h(t12)、24 h(t24)及36 h(t36)时心率、平均动脉压、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI),计算各时点的氧合指数(PaO2/FiO2).在造模前、t0时及不同处理后12、24、36 h分别对家猪进行肺组织穿刺,采用苏木精-伊红(HE)染色法观察肺组织病理变化,并对肺组织进行肺损伤评分.结果 (1)组间比较:造模前及t0时,4组家猪EVLWI和肺组织病理评分的差异无统计学意义(P＞0.05);在不同处理后12、24、36hEVLWI和肺组织病理评分的差异均有统计学意义(P＜0.05).组内比较:t0时,4组家猪EVLWI和肺组织病理评分均较造模前明显上升,差异有统计学意义(P＜0.05);在不同处理后,PQ染毒对照组家猪的EVLWI和肺组织病理评分持续升高,5、15、30 mg/kg甲泼尼龙组家猪EVLWI和肺组织病理评分均呈先下降后升高趋势,与组内t0比较,差异均有统计学意义(P＜0.05).(2)组间比较:造模前及t0时,4组家猪氧合指数差异无统计学意义(P＞0.05),在不同处理后12、24、36 h,氧合指数的差异均有统计学意义(P＜0.05).组内比较:t0时,4组家猪氧合指数均较造模前明显下降,差异有统计学意义(P＜0.05);在不同处理后,PQ染毒对照组家猪的氧合指数持续降低,5、15、30 mg/kg甲泼尼龙组家猪的氧合指数呈先升高后下降趋势,与组内t0比较,差异均有统计学意义(P＜0.05).(3)各组药物治疗36 h后的EVLWI值与各组肺相应氧合指数呈负相关(r=-0.427,P=0.022),并与肺组织病理半定量评分呈明显正相关(r=0.903,P=0.034).结论 甲泼尼龙可有效减轻急性PQ中毒ALFARDS家猪的肺损伤,并改善氧合状况.在PQ中毒家猪ALI/ARDS造模成功后的24 h内,以30 mg/kg甲泼尼龙组改善肺损伤的效果较好,在24～36 h内,以15mg/kg甲泼尼龙组的治疗效果最佳.
    목적 관찰갑발니룡치료급성백초고(PQ)중독가저폐손상적최가제량.방법 취20 ml함20％PQ원액대가저진행복강주사,제비급성PQ중독가저급성폐손상(ALI)/급성호흡군박종합정(ARDS)모형,장조모성공적가저모형수궤분위PQ염독대조조,5、15、30 mg/kg갑발니룡조.4조가저모형균재상규보액기출상급여간예,채용맥박지시련속심배혈량(PICCO)감측조모전、조모성공시(t0)、불동처리지후12 h(t12)、24 h(t24)급36 h(t36)시심솔、평균동맥압、혈관외폐수지수(EVLWI)、폐혈관통투성지수(PVPI),계산각시점적양합지수(PaO2/FiO2).재조모전、t0시급불동처리후12、24、36 h분별대가저진행폐조직천자,채용소목정-이홍(HE)염색법관찰폐조직병리변화,병대폐조직진행폐손상평분.결과 (1)조간비교:조모전급t0시,4조가저EVLWI화폐조직병리평분적차이무통계학의의(P＞0.05);재불동처리후12、24、36hEVLWI화폐조직병리평분적차이균유통계학의의(P＜0.05).조내비교:t0시,4조가저EVLWI화폐조직병리평분균교조모전명현상승,차이유통계학의의(P＜0.05);재불동처리후,PQ염독대조조가저적EVLWI화폐조직병리평분지속승고,5、15、30 mg/kg갑발니룡조가저EVLWI화폐조직병리평분균정선하강후승고추세,여조내t0비교,차이균유통계학의의(P＜0.05).(2)조간비교:조모전급t0시,4조가저양합지수차이무통계학의의(P＞0.05),재불동처리후12、24、36 h,양합지수적차이균유통계학의의(P＜0.05).조내비교:t0시,4조가저양합지수균교조모전명현하강,차이유통계학의의(P＜0.05);재불동처리후,PQ염독대조조가저적양합지수지속강저,5、15、30 mg/kg갑발니룡조가저적양합지수정선승고후하강추세,여조내t0비교,차이균유통계학의의(P＜0.05).(3)각조약물치료36 h후적EVLWI치여각조폐상응양합지수정부상관(r=-0.427,P=0.022),병여폐조직병리반정량평분정명현정상관(r=0.903,P=0.034).결론 갑발니룡가유효감경급성PQ중독ALFARDS가저적폐손상,병개선양합상황.재PQ중독가저ALI/ARDS조모성공후적24 h내,이30 mg/kg갑발니룡조개선폐손상적효과교호,재24～36 h내,이15mg/kg갑발니룡조적치료효과최가.
    Objective To observe the best dose of methylprednisolone improving lung injury in swine with paraquat intoxication.Methods Acute lung injury (ALI/ARDS) model was made by an intraperitoneal injection of a large dose of 20％ PQ solution20 millilitres in swine.Then 24 swine were randomly divided into 4 groups:exposed PQ control group,5 mg/kg of methylprednisoloue group,15 mg/kg of methylprednisolone group,30 mg/kg of methylprednisolone group.All groups were based on the conventional rehydration for intervention,Arterial blood samples were collected before modeling and 0,12,24,36 hours after different processing for blood gas analysis.At the same time heart rate (HR),mean arterial pressure (MAP),extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were measured by using PICCO (pulse indicator continuous cardiac output),lung tissue was obtained by punctureneedle to produce lung biopsy,then observe the pathological changes of lung tissue in the microscope.Results 1.Comparison between groups:there is no significant difference about extravascular lung water index (EVLWI)and semi-quantitative score of lung tissue pathology in four groups (P＞0.05) before modeling,so is t0,there is significant difference at about extravascular lung water index and semi-quantitative score of lung tissue pathology 12 h,24 h and 36 h after different processing (P＜0.05).Within the group:EVLWI and semi-quantitative score of Lung tissue pathology in four groups significantly increased when the model was made (P＜0.05),after different processing,EVLWI and semi-quantitative score of Lung tissue pathology in exposed PQ control group kept going up,in other three groups,EVLWI and semi-quantitative score of lung tissue pathology went down first and then went up,there is significant difference compared with t0 (P＜0.05).2.Comparison between groups:there is no significant difference about oxygenation index in four groups (P＞0.05) before modeling,so is t0,there is significant difference about oxygenation at 12 h,24 h and 36 h after different processing (P＜0.05).Within the group:oxygenation index in four groups significantly decreased when the model was made (P＜0.05),after different processing,oxygenation index in exposed PQ control group kept going down,in other three groups,it showed a downward trend after the first rise,there is significant difference compared with t0 (P＜0.05).3.After medication for 36h,correlation analysis showed that EVLWI were negatively associated with oxygenation index (r=-0.427,P=0.022)and positively associated with semi-quantitative score of Lung tissue pathology(r=0.903,P=0.034).Conclusion Methylprednisolone can obviously relieve lung injury caused by paraquat poisoning and improve oxygenation.After the model was made,within 24 hours,30 mg/kg of methylprednisolone have advantage for the PQ poisoning swine,but 15mg/kg of methylprednisolone is best for improving lung injury induced by paraquat intoxication within 24 hours to 36 hours.
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