急性一氧化碳中毒大鼠急性肺损伤的实验研究

Study of acute lung Injury in rats with acute carbon monoxid poisoning(ACOP)

目的制备大鼠急性一氧化碳中毒(ACOP)模型,观察肺损伤的病理学与病理生理学变化,比较氧合指数和碳氧血红蛋白(HbCO)与急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的相关性。方法健康Wistar大鼠静式吸入一氧化碳(CO)1h建立ACOP模型,对照组20只,中毒组按吸入CO浓度分为轻(A组)、中(B组)、重(C组)三组,每组20只。染毒后,分别检测各组动脉血气分析、HbCO浓度。取肺组织切片,观察病理学改变,根据检查结果进行统计学分析。结果B组和C组CO中毒的ALI/ARDS发生率分别为25%和55%,均明显高于对照组(P<0.05,P<0.01);A、B、C组的动脉血HbCO均明显高于对照组(P<0.01),而动脉血PaO_2均明显低于对照组(P<0.01)。ALI/ARDS组的动脉血HbCO(62.4±19.1)%明显高于非ALI/ARDS组(29.9±13.8)%(P<0.01);ALI/ARDS组的动脉血PaO_2(51.3±13.1)明显低于非ALI/ARDS组(79.0±15.8)(P<0.01);ALI/ARDS组的动脉血A-aDO_2(37.6±27.9)mmHg亦高于非ALI/ARDS组(24.2±15.7)mmHg(P<0.05);而ALI/ARDS组的动脉血PaCO_2(43.5±15.4)与非ALI/ARDS组(41.0±6.4)比较,差异无统计学意义(P<0.05)。HbCO与氧合指数(本文与动脉氧分压PaO_2表示)两指标诊断ALI/ARDS差异有统计学意义(P<0.05)。根据本实验数据制定诊断截断值,即:ACOP患者动脉血HbCO>43%即可认为有ALI/ARDS的发生。结论ACOP可导致ALI/ARDS的发生与低张性缺氧;与氧合指数比较,HbCO浓度诊断ALI/ARDS更灵敏。

Objective To structure the model of acute carbon monoxid poisoning （ACOP） in rats. Evaluate the effectiveness of the poisoning on the pulmonary function and the significance of carbon monoxide hemoglobin （HbCO） and oxygenation index in diagnosis of acute lung injury （ALI）/acute respiratory distress syndrome （ARDS）. Method Eighty healthy adult male Wistar rats were randomized into 4 groups. According to the concentration of CO, poisoning group was randomized into three groups （each group = 20）, group A, group B, group C. After poisoned, arterial blood was collected rapidly for arterial blood gas analysis. According to the pathological changes, the models were divided into ALI/ARDS group and non-ALI/ARDS group. Results Compared with control group, the incident rate of ALI/ARDS in group B （25%） and group C （55%） were significantly higher （P 〈 0.05, P 〈 0.01）. The plasma HbCO was markedly higher in group A, group B and group C than in control group （P 〈 0.01）, while PaO2 was markedly lower （P 〈 0.01）. The plasma HbCO （62.4±19.1）%, and A-a DO2 （37.6±27.9） in ALI/ARDS group was significantly higher than those in non-ALI/ARDS group [（29.9±13.8）%, （24.2±15.7） mmHg （P 〈 0.05）], while PaO2 （51.3±13.1） in ALI/ARDS group was significantly lower than that in non-ALI/ARDS group （79.0±15.8） （ P 〈 0.05 ）, and there was no significance between ALI/ARDS group and non-ALI/ARDS group on PaCO2 [（43.5±15.4） vs. （41.0±6.4）] A statistically significant difference existed between PaO2 and HbCO in siagnosing ALI/ARDS （P 〈 0.05）. Conclusions ACOP leads to ALI/ARDS, there was a positive correlation between plasma levels of HbCO and PaO2. HbCO is more accurate to diagnose ARDS than PaO2.