CAJ | 학술논문

目的：研究7.5％氯化钠／6％右旋糖苷‐70（HSD）的复方高渗盐溶液对脓毒症大鼠血浆免疫因子水平及生存率的影响，以及对脓毒症并发急性肺损伤（ALI）的治疗作用。方法雄性Wistar大鼠133只，分为假手术组、盲肠结扎穿孔术（CLP）组、CLP＋生理盐水（NS）组、CLP＋ HSD组等4组。采用CLP方法制备脓毒症大鼠模型，假手术组除不结扎和穿刺盲肠外，其余手术步骤相同。4组大鼠术毕均皮下注射NS ，30 mL／kg ；CLP＋NS组、CLP＋ HSD组分别于术后3 h自颈静脉内输注NS（或HSD），5 mL／kg[0.4 mL／（kg · min）]。各组于手术后0、9、18 h采集动脉血标本用于检测血浆肿瘤坏死因子α（T N F‐α）、白细胞介素1β（IL‐1β），并进行血气分析。各组术后9、18 h统计大鼠生存率。术后18 h检测大鼠肺组织支气管肺泡灌洗液（BALF）中性粒细胞比例、肺组织髓过氧化物酶（MPO）活性、计算肺组织湿干重比值，并观察肺组织病理切片改变。结果与CLP组及CLP＋NS组相比，CLP＋ HSD组术后9、18 h血浆TNF‐α、IL‐1β水平明显降低（均 P＜0.05）。术后18 h CLP＋ HSD组大鼠动脉血pH值、PaO2、PaCO2比CLP组及CLP＋NS组大鼠有所改善。CLP＋ HSD组大鼠9、18 h生存率分别为85.7％、64.3％，比CLP组及CLP＋ NS组有明显改善（均 P＜0.05）。CLP＋ HSD组BALF中性粒细胞比例、肺组织MPO活性及肺湿干重比均比CLP组及CLP＋NS组有明显降低（均 P＜0.05）。CLP组及CLP＋ NS组肺组织表现为淤血、水肿，浸润性炎性改变，CLP＋ HSD组肺组织炎性改变比CLP组及CLP＋NS组有明显改善。结论复方高渗盐溶液对脓毒症大鼠的急性肺损伤有治疗作用，并提高了脓毒症大鼠生存率。
목적：연구7.5％록화납／6％우선당감‐70（HSD）적복방고삼염용액대농독증대서혈장면역인자수평급생존솔적영향，이급대농독증병발급성폐손상（ALI）적치료작용。방법웅성Wistar대서133지，분위가수술조、맹장결찰천공술（CLP）조、CLP＋생리염수（NS）조、CLP＋ HSD조등4조。채용CLP방법제비농독증대서모형，가수술조제불결찰화천자맹장외，기여수술보취상동。4조대서술필균피하주사NS ，30 mL／kg ；CLP＋NS조、CLP＋ HSD조분별우술후3 h자경정맥내수주NS（혹HSD），5 mL／kg[0.4 mL／（kg · min）]。각조우수술후0、9、18 h채집동맥혈표본용우검측혈장종류배사인자α（T N F‐α）、백세포개소1β（IL‐1β），병진행혈기분석。각조술후9、18 h통계대서생존솔。술후18 h검측대서폐조직지기관폐포관세액（BALF）중성립세포비례、폐조직수과양화물매（MPO）활성、계산폐조직습간중비치，병관찰폐조직병리절편개변。결과여CLP조급CLP＋NS조상비，CLP＋ HSD조술후9、18 h혈장TNF‐α、IL‐1β수평명현강저（균 P＜0.05）。술후18 h CLP＋ HSD조대서동맥혈pH치、PaO2、PaCO2비CLP조급CLP＋NS조대서유소개선。CLP＋ HSD조대서9、18 h생존솔분별위85.7％、64.3％，비CLP조급CLP＋ NS조유명현개선（균 P＜0.05）。CLP＋ HSD조BALF중성립세포비례、폐조직MPO활성급폐습간중비균비CLP조급CLP＋NS조유명현강저（균 P＜0.05）。CLP조급CLP＋ NS조폐조직표현위어혈、수종，침윤성염성개변，CLP＋ HSD조폐조직염성개변비CLP조급CLP＋NS조유명현개선。결론복방고삼염용액대농독증대서적급성폐손상유치료작용，병제고료농독증대서생존솔。
Objective To study the effect of compound hypertonic saline solution containing 7.5% NaCl/6% dextran‐70 (HSD)on the levels of plasma immune factors and survival rate of septic rats ,and explore their therapeutic effects on acute lung injury of septic rats.Methods In total ,133 male Wistar rats were divided into four groups ,including the sham operation group (SOP) ,CLP group ,CLP plus NS group and CLP plus HSD group.A rat model of sepsis was established by cecal ligation and puncture(CLP).The rats in sham operation group received celiotomy without ligation and puncture.All rats in four groups re‐ceived subcutaneous injection of 30 mL/kg 0.9% sodium chloride after laparotomy.The rats in CLP plus NS group and CLP plus HSD group received infusion of 5 mL/kg 0.9% sodium chloride or HSD post CLP via jugular vein 3 h after surgery ,with the infusion rate of 0.4 mL/(kg · min).The blood specimens were collected from all rats 0 ,9 and 18 h after surgery ,respective‐ly ,for detection of the plasma levels of tumor necrosis factor‐α(TNF‐α) ,interleukin‐1β(IL‐1β)and arterial blood gas analy‐sis.The survival rate of each group was observed 9 and 18 h after laparotomy.The lung tissues were taken for detection of the neutrophil proportion in bronchoalveolar lavage fluid(BALF) ,myeloperoxidase(MPO)activity in lung tissues ,calculation of the wet‐dry weight ratio of lung tissues ,and pathological changes of the sections of lung tissues 18 h after surgery were ob‐served.Results The serum levels of TNF‐α and IL‐1β were significantly lower in the CLP plus HSD group than in the CLP group and the CLP plus NS group 9 and 18 h after surgery(P<0.05).The arterial partial oxygen pressure and arterial partial pressure of carbon dioxide in the CLP plus HSD group were significantly improved as compared with the CLP group and the CLP plus NS group 18 h after surgery.The survival rates 9 and 18 h after surgery were 62.2% and 31.1% in the CLP group , 57.8% and 35.6% in the CLP plus NS group ,85.7% and 64.3% in the CLP plus HSD group ,which were all significantly im‐proved as compared with the CLP group and the CLP plus NS group (P<0.05).The neutrophil proportion in BALF ,MPO ac‐tivity and lung wet‐dry weight ratio in lung tissues were all significantly lower in the CLP plus HSD group than in the CLP group and the CLP plus NS group(P<0.05).Congestion ,edema ,infiltrating inflammatory changes were present in the lung tis‐sues in the CLP group and the CLP plus NS group ,and the inflammatory changes in the lung tissue in the CLP plus HSD group were significantly improved as compared with the CLP group and the CLP plus NS group.Conclusion HSD exerts a therapeu‐tic effect on acute lung injury of septic rats and increases the survival rate of them.