中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
2期
133-137
,共5页
李百玲%柴家科%胡泉%张旭龙%张东海%马丽%郁永辉%刘玲英
李百玲%柴傢科%鬍泉%張旭龍%張東海%馬麗%鬱永輝%劉玲英
리백령%시가과%호천%장욱룡%장동해%마려%욱영휘%류령영
肺表面活性物质相关蛋白质类%烧冲复合伤%急性肺损伤
肺錶麵活性物質相關蛋白質類%燒遲複閤傷%急性肺損傷
폐표면활성물질상관단백질류%소충복합상%급성폐손상
Pulmonary surfactant-associated proteins%Burn blast combined injury%Acute lung injury
目的 观察外源性肺泡表面活性物质对重度烧冲复合伤大鼠急性肺损伤的治疗作用.方法 健康雄性SD大鼠180只,用随机数表法分为假伤组、治疗组、对照组各60只,每组致伤前0h及伤后6、24、48、72 h共5个观察时相点各12只.进行如下处理:(1)假伤组:脱毛12 h后,以3％戊巴比妥钠30 mg/kg腹腔内注射麻醉,将背部脱毛区域置入37℃水中持续12s;(2)治疗组:参照既往大鼠重度烧冲复合伤模型,致伤后立即经气管插管滴注外源性肺泡表面活性物质即猪肺磷脂注射液2 ml/kg;(3)对照组:参照既往大鼠重度烧冲复合伤模型,致伤后立即经气管插管滴注等量的生理盐水2 ml/kg.分别于致伤前0h及伤后6、24、48、72 h监测大鼠动脉血氧分压(PaO2)及二氧化碳分压(PaCO2),测定各组大鼠肺功能,留取肺组织,行病理观察.结果 除去实验过程中的死亡损耗后,最终3组5个时相点分别均衡纳入8只大鼠进行统计学分析.PaO2:对照组6、24、48、72 h各时相点均显著低于假伤组[(69.55±5.11)、(62.05±6.54)、(53.24±7.65)、(50.00±7.45)比(93.75±3.41)、(94.25±2.19)、(93.63±2.33)、(93.25±1.83) mmHg(1 mmHg =0.133 kPa),均P＜0.05];治疗组6h接近假伤组[(92.63±3.74)比(93.75±3.41)mmHg,P=0.594];对照组6h时即降至70 mmHg左右,随后逐渐下降,而治疗组各时相点均显著高于对照组[(92.63±3.74)、(87.50±3.34)、(78.75±3.11)、(71.38±3.74)比(69.55±5.11)、(62.05±6.54)、(53.24±7.65)、(50.00±7.45) mmHg,均P＜0.05].PaCO2:治疗组在6、24、48 h显著低于对照组[(45.50±6.79)、(49.38±7.52)、(54.13±4.82)比(53.25±2.76)、(59.50±6.61)、(63.60±7.33) mmHg,均P＜0.05],72 h时而治疗组与对照组均显著高于假伤组[(59.63±6.87)、(68.88±6.85)比(36.38±1.85) mmHg,均P＜0.05],而治疗组与对照组差异无统计学意义(P =0.051).治疗组深吸气量、中心气道阻力、肺顺应性及组织弹性在24h时显著优于对照组(均P＜0.05),与假伤组接近(P＞0.05);治疗组肺泡结构破坏程度以及肺出血、水肿程度均较对照组轻.结论 外源性肺泡表面活性物质对重度烧冲复合伤大鼠急性肺损伤具有明显的治疗作用,可改善氧合,减轻肺水肿及肺毛细血管膜的通透性.
目的 觀察外源性肺泡錶麵活性物質對重度燒遲複閤傷大鼠急性肺損傷的治療作用.方法 健康雄性SD大鼠180隻,用隨機數錶法分為假傷組、治療組、對照組各60隻,每組緻傷前0h及傷後6、24、48、72 h共5箇觀察時相點各12隻.進行如下處理:(1)假傷組:脫毛12 h後,以3％戊巴比妥鈉30 mg/kg腹腔內註射痳醉,將揹部脫毛區域置入37℃水中持續12s;(2)治療組:參照既往大鼠重度燒遲複閤傷模型,緻傷後立即經氣管插管滴註外源性肺泡錶麵活性物質即豬肺燐脂註射液2 ml/kg;(3)對照組:參照既往大鼠重度燒遲複閤傷模型,緻傷後立即經氣管插管滴註等量的生理鹽水2 ml/kg.分彆于緻傷前0h及傷後6、24、48、72 h鑑測大鼠動脈血氧分壓(PaO2)及二氧化碳分壓(PaCO2),測定各組大鼠肺功能,留取肺組織,行病理觀察.結果 除去實驗過程中的死亡損耗後,最終3組5箇時相點分彆均衡納入8隻大鼠進行統計學分析.PaO2:對照組6、24、48、72 h各時相點均顯著低于假傷組[(69.55±5.11)、(62.05±6.54)、(53.24±7.65)、(50.00±7.45)比(93.75±3.41)、(94.25±2.19)、(93.63±2.33)、(93.25±1.83) mmHg(1 mmHg =0.133 kPa),均P＜0.05];治療組6h接近假傷組[(92.63±3.74)比(93.75±3.41)mmHg,P=0.594];對照組6h時即降至70 mmHg左右,隨後逐漸下降,而治療組各時相點均顯著高于對照組[(92.63±3.74)、(87.50±3.34)、(78.75±3.11)、(71.38±3.74)比(69.55±5.11)、(62.05±6.54)、(53.24±7.65)、(50.00±7.45) mmHg,均P＜0.05].PaCO2:治療組在6、24、48 h顯著低于對照組[(45.50±6.79)、(49.38±7.52)、(54.13±4.82)比(53.25±2.76)、(59.50±6.61)、(63.60±7.33) mmHg,均P＜0.05],72 h時而治療組與對照組均顯著高于假傷組[(59.63±6.87)、(68.88±6.85)比(36.38±1.85) mmHg,均P＜0.05],而治療組與對照組差異無統計學意義(P =0.051).治療組深吸氣量、中心氣道阻力、肺順應性及組織彈性在24h時顯著優于對照組(均P＜0.05),與假傷組接近(P＞0.05);治療組肺泡結構破壞程度以及肺齣血、水腫程度均較對照組輕.結論 外源性肺泡錶麵活性物質對重度燒遲複閤傷大鼠急性肺損傷具有明顯的治療作用,可改善氧閤,減輕肺水腫及肺毛細血管膜的通透性.
목적 관찰외원성폐포표면활성물질대중도소충복합상대서급성폐손상적치료작용.방법 건강웅성SD대서180지,용수궤수표법분위가상조、치료조、대조조각60지,매조치상전0h급상후6、24、48、72 h공5개관찰시상점각12지.진행여하처리:(1)가상조:탈모12 h후,이3％무파비타납30 mg/kg복강내주사마취,장배부탈모구역치입37℃수중지속12s;(2)치료조:삼조기왕대서중도소충복합상모형,치상후립즉경기관삽관적주외원성폐포표면활성물질즉저폐린지주사액2 ml/kg;(3)대조조:삼조기왕대서중도소충복합상모형,치상후립즉경기관삽관적주등량적생리염수2 ml/kg.분별우치상전0h급상후6、24、48、72 h감측대서동맥혈양분압(PaO2)급이양화탄분압(PaCO2),측정각조대서폐공능,류취폐조직,행병리관찰.결과 제거실험과정중적사망손모후,최종3조5개시상점분별균형납입8지대서진행통계학분석.PaO2:대조조6、24、48、72 h각시상점균현저저우가상조[(69.55±5.11)、(62.05±6.54)、(53.24±7.65)、(50.00±7.45)비(93.75±3.41)、(94.25±2.19)、(93.63±2.33)、(93.25±1.83) mmHg(1 mmHg =0.133 kPa),균P＜0.05];치료조6h접근가상조[(92.63±3.74)비(93.75±3.41)mmHg,P=0.594];대조조6h시즉강지70 mmHg좌우,수후축점하강,이치료조각시상점균현저고우대조조[(92.63±3.74)、(87.50±3.34)、(78.75±3.11)、(71.38±3.74)비(69.55±5.11)、(62.05±6.54)、(53.24±7.65)、(50.00±7.45) mmHg,균P＜0.05].PaCO2:치료조재6、24、48 h현저저우대조조[(45.50±6.79)、(49.38±7.52)、(54.13±4.82)비(53.25±2.76)、(59.50±6.61)、(63.60±7.33) mmHg,균P＜0.05],72 h시이치료조여대조조균현저고우가상조[(59.63±6.87)、(68.88±6.85)비(36.38±1.85) mmHg,균P＜0.05],이치료조여대조조차이무통계학의의(P =0.051).치료조심흡기량、중심기도조력、폐순응성급조직탄성재24h시현저우우대조조(균P＜0.05),여가상조접근(P＞0.05);치료조폐포결구파배정도이급폐출혈、수종정도균교대조조경.결론 외원성폐포표면활성물질대중도소충복합상대서급성폐손상구유명현적치료작용,가개선양합,감경폐수종급폐모세혈관막적통투성.
Objective To observe the therapeutic effects of exogenous pulmonary surfactant (PS) on acute lung injury induced by severe burn-blast combined injury in a rat model.Methods A total of 180 adult male SD rats were randomly divided into 3 groups of sham,treatment and control (n =60 each).Severe burn-blast combined injury was induced by inflicting rats with a moderate blast injury and a full-thickness burn injury of 25％ total body surface area.The treatment and control groups received exogenous PS (2 ml/kg) and saline (2 ml/kg) by trachea respectively.At the time points of 0,6,24,48 and 72 h,12 rats per timepoint in each group underwent PaO2,PaCO2 and pulmonary function tests respectively.And they were then sacrificed for other analyses.Lung tissues were harvested for histological studies.Their arterial blood samples were collected for blood gas analysis.All data were expressed as mean ± standard deviation and analyzed with SPSS 20.0 (SPSS Inc.,Chicago,IL,USA).The differences were considered to be statistically significant at P ＜ 0.05.Results After removing death drain during the experiment,8 rats were put equally into five phase points of the last three groups,the results were analyzed statistically.PaO2:At each timepoint of 6,24,48,72 h,the control group PaO2 were obviously lower than the sham group ((69.55 ±5.11),(62.05 ±6.54),(53.24 ±7.65),(50.00 ±7.45) vs (93.75 ±3.41),(94.25 ± 2.19),(93.63 ±2.33),(93.25 ±1.83) mmHg (1 mmHg =0.133 kPa),all P＜0.01); at 6 h treatment group was close to sham group ((92.63 ±3.74) vs (93.75 ±3.41) mmHg,P =0.594) ; at 6 h control group PaO2 decreased to 70 mmHg and then gradually declined.And at each timepoint the treatment group PaO2 was significantly higher than the control group ((92.63 ± 3.74),(87.50 ± 3.34),(78.75 ± 3.11),(71.38 ±3.74) vs (69.55 ±5.11),(62.05 ±6.54),(53.24 ±7.65),(50.00 ±7.45) mmHg,all P ＜ 0.01) ; PaCO2:treatment group PaCO2 was lower than that of control group at 6,24,48 h ((45.50±6.79),(49.38±7.52),(54.13±4.82) vs (53.25 ±2.76),(59.50±6.61),(63.60± 7.33) mmHg,all P ＜ 0.01),both treatment and control groups were significantly higher than those in the sham group ((59.63 ±6.87),(68.88 ±6.85) vs (36.38 ± 1.85) mmHg,all P ＜0.01).No difference existed between the control and treatment groups (P =0.051).Deep inspiratory capacity,central airway resistance,lung compliance and tissue elasticity,treatment group was significantly better than control group at 24 h (P ＜ 0.05).And it was close to sham group (P ＞ 0.05).The treatment group alveolar structural damage and pulmonary hemorrhage and edema were better than those in the control group.Conclusion Exogenous pulmonary surfactant (PS) can improve oxygenation and alleviate pulmonary edema and pulmonary capillary membrane permeability of rats with severe burn blast combined injury.
