外源性肺泡表面活性物质对兔子盐酸吸入性肺损伤的治疗作用

Treatment of porcine pulmonary surfactant for hydrochloric acid induced early stage acute lung injury in rabbit

目的观察外源性自制猪肺表面活性物质对盐酸诱导急性肺损伤兔的治疗作用。方法健康兔18只，随机分为3组，即健康对照组、模型组、治疗组，每组6只。模型组和治疗组兔子麻醉后，经气管导管注入pH=1．5的盐酸2ml／kg，复制盐酸吸入性肺损伤模型；对照组经气管导管注入同等量生理盐水。治疗组在盐酸注入后4h经气管导管给予猪肺表面活性物质120mg／kg（浓度为80g／L）进行干预；健康对照组及模型组在相应时间经气管导管给予同等体积的生理盐水。之后共观察6h，并监测各预设时间点PaO2、PaCO2，处死后检测左下肺组织湿／干重比（W／D），支气管肺泡灌洗液（BALF）中总蛋白（TP）含量和白细胞（WBC）总数，并观察左上肺组织病理学改变。结果治疗组经猪肺表面活性物质治疗后各时间点的PaO2高于模型组（P值均〈0．01），但多数时间点仍低于健康对照组（P值均〈0．01），各时间点的PaCO2均低于模型组（P值均〈0．01），高于健康对照组（P值均〈0．01）。与模型组相比，治疗组左下肺W／D、BALF中TP含量和WBC明显降低（P值均〈0．01），仍高于健康对照组（P值均〈0．01）。组织病理学观察显示：与模型组相比，治疗组兔肺损伤程度较轻，但仍然无法恢复到健康对照组的水平。结论猪肺表面活性物质可以明显提高PaO2，降低PaCO2、左下肺W／D、BALF中TP含量和WBC数目，改善肺组织病理学结构。对家兔盐酸吸入肺损伤具有治疗作用，为临床胃液误吸性肺损伤的治疗提供了一种新方法。

Objective To evaluate the therapeutic efficacy of intratracheal instillation of porcine pulmonary surfactant（PPS） on rabbits with hydrochloric acid induced early stage acute lung injury. Methods Eighteen healthy adult rabbits weighing 1.7-2.3 kg were randomly divided into healthy control group, model group and treatment group（6 in a group）. The model of acute lung injury was set up in each of the animals of the model group and treatment group by intratracheal instillation of hydrochloric acid（pH=1.5, 2 ml/kg）. Normal saline was given for the healthy control group. PPS （120 mg/kg, 80 g/L）was administered 4 hours after hydrochloric acid instillation in the treatment group. While the healthy control group and model group were treated with normal saline instead of PPS at the same time. PaO2 and PaCO2 were examined for 10 hours after the start of experiment. The rabbits were killed and left lung was immediately deligated and removed. Left top lung was used for histological analysis,left lower lung was used for examining the ratio of wet and dry mass. The bronehoalveolar lavage fluid （BALF） of right lung was collected for measurement of total protein contents,total white blood cell numbers. Results PaO2 was higher in the treatment group than that in the model group （all P 〈0.01）,but most of them were lower than that in the healthy control group （all P〈0. 01）. PaCO2 in the treatment group was lower than that in the model group （all P 〈0.01） ,but higher than that in the healthy control group （all P 〈0.01）. Compared with the model group, the ratio of wet and dry mass of left lower lung, the total protein and total white blood cell numbers in BALF significantly decreased in the treatment group （all P 〈0.01）, but higher than those in the healthy control group （all P 〈0. 01）. The histological appearance meliorated in the treatment group compared with the model group,but remained to be inferior to the healthy control group. Conclusions PPS can improve PaO2 and PaCO2. The ratio of wet and dry lung,the number of white blood cell and total protein content in BALF in the treatment group were significantly lower than those in the model group. The histological appearance of the treatment group improves significantly. So it has benefits in the treatment of lung injury induced by aspiration of hydrochloric acid.