CAJ | 학술논문

目的探讨乌司他丁联合地塞米松对兔爆震伤后急性肺损伤(ALI)的治疗作用.方法选择健康新四兰大白兔54只中46只制作肺爆震伤ALI模型,其中38只建模成功,8只建模失败.38只按随机数字表法分为损伤组(8只)、治疗Ⅰ组(单纯给予地塞米松,10只),治疗Ⅱ组(单纯给予乌司他丁,10只)和联合治疗组(给予地塞米松+乌司他丁,10只),另8只未受爆震伤动物为对照组.治疗Ⅰ、Ⅱ组和联合治疗组造模成功后0.5,12,24,36,48 h肌肉注射给予相应药物,对照组和损伤组给予等体积等渗盐水.检测伤后即刻及治疗后6,24,48,72 h各组呼吸次数、氧合指数(PaO2/FiO2)及外周静脉血肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8、中性粒细胞弹性蛋白酶(NE)含量;治疗后72 h处死动物,收集支气管肺泡灌洗液(BALF),检测其中TNF-α、IL-6、IL-8及NE含量,取肺组织测定肺湿/干比重值,并行HE染色观察肺组织病理变化. 结果各时相点损伤组呼吸次数均较其他各组高,6h时最高(75.0±7.4)次/min,较对照组(33.0±4.5)次/min明显升高(P＜0.01);肺湿/干比重及外周血、BALF中的TNF-α、IL-6、IL-8含量均较对照组明显升高(P＜0.01).损伤组72 h时PaO2/FiO2最低(180.5±12.6) mmHg,较对照组(403.7±8.0) mmHg明显降低(P＜0.01).治疗Ⅰ、Ⅱ组及联合治疗组各指标均有不同程度改善,其中联合治疗组明显优于治疗Ⅰ、Ⅱ组(P＜0.01).与损伤组比较,治疗Ⅰ、Ⅱ组肺组织出血、水肿及炎细胞浸润均较轻,联合治疗组损伤程度最轻;治疗Ⅰ、Ⅱ组比较无明显差异. 结论乌司他丁联合地塞米松对兔爆震伤所致ALI具有一定治疗作用,且疗效明显优于单用乌司他丁或地塞米松.
목적 탐토오사타정연합지새미송대토폭진상후급성폐손상(ALI)적치료작용.방법 선택건강신사란대백토54지중46지제작폐폭진상ALI모형,기중38지건모성공,8지건모실패.38지안수궤수자표법분위손상조(8지)、치료Ⅰ조(단순급여지새미송,10지),치료Ⅱ조(단순급여오사타정,10지)화연합치료조(급여지새미송+오사타정,10지),령8지미수폭진상동물위대조조.치료Ⅰ、Ⅱ조화연합치료조조모성공후0.5,12,24,36,48 h기육주사급여상응약물,대조조화손상조급여등체적등삼염수.검측상후즉각급치료후6,24,48,72 h각조호흡차수、양합지수(PaO2/FiO2)급외주정맥혈종류배사인자-α(TNF-α)、백세포개소-6(IL-6)、IL-8、중성립세포탄성단백매(NE)함량;치료후72 h처사동물,수집지기관폐포관세액(BALF),검측기중TNF-α、IL-6、IL-8급NE함량,취폐조직측정폐습/간비중치,병행HE염색관찰폐조직병리변화. 결과 각시상점손상조호흡차수균교기타각조고,6h시최고(75.0±7.4)차/min,교대조조(33.0±4.5)차/min명현승고(P＜0.01);폐습/간비중급외주혈、BALF중적TNF-α、IL-6、IL-8함량균교대조조명현승고(P＜0.01).손상조72 h시PaO2/FiO2최저(180.5±12.6) mmHg,교대조조(403.7±8.0) mmHg명현강저(P＜0.01).치료Ⅰ、Ⅱ조급연합치료조각지표균유불동정도개선,기중연합치료조명현우우치료Ⅰ、Ⅱ조(P＜0.01).여손상조비교,치료Ⅰ、Ⅱ조폐조직출혈、수종급염세포침윤균교경,연합치료조손상정도최경;치료Ⅰ、Ⅱ조비교무명현차이. 결론 오사타정연합지새미송대토폭진상소치ALI구유일정치료작용,차료효명현우우단용오사타정혹지새미송.
Objective To discuss the therapeutic effect of ulinastatin combined with dexamethasone on blast-induced acute lung injury (ALI) in rabbits.Methods Thirty-eight New Zealand white rabbits with blast-induced ALI were divided into four groups according to the random number table:injury group (n =8),treatment group Ⅰ (dexamethasone alone,n =10),treatment group Ⅱ (ulinastatin alone,n =10),combination therapy group (dexamethasone + ulinastatin,n =10).In addition,8 uninjured rabbits were randomly selected as control group.Treatment groups were given relevant medication by intramuscular injection at 0.5,12,24,36 and 48 hours after successful modeling.Injury group and control group were given equal volume of isotonic saline at the same time.Parameters of respiratory rate,oxygenation index (PaO2/FiO2),TNF-α,IL-6,IL-8 and neutrophil elastase (NE)were detected before and afterfirst treatment at 6,24,48 and 72 hours.All rabbits were sacrificed after 72 hoars to detect TNF-α,IL-6,IL-8 and NE contents in bronchoalveolar lavage fluid (BALF) and to measure wet to dry lung weight ratio.HE staining was performed to observe pathological changes of lung tissues Results In contrast,respiratory rate was high in injury group at each time point,which increased to the peak (75.0 ± 7.4) times/min at 6 hours far higher than (33.0 ± 4.5) times/min in control group (P ＜0.01).Wet to dry lung weight ratio and TNF-α,IL-6 as well as IL-8 contents of the peripheral blood and BAI.F in injury group were significantly higher than those in control group (P ＜0.01).PaO2/ FiO2 in injury group was decreased to the lowest level of (180.5 ± 12.6)mmHg at 72 hours far lower than (403.7-8.0)mmHg in control group (P ＜0.01).While improvements were observed in treatment groups with respect to these indicators,and significantly much better results were detected in combination therapy group rather than in treatment groups Ⅰ and Ⅱ (P ＜ 0.01).Conclusion Ulinastatin combined with dexamethasone is an effective therapy on blast-induced ALI in rabbits,and the effect is significantly better than that with single use of uliinastatin or dexamethasone.