高频振荡通气及与肺表面活性物质联用对吸入性损伤家兔肺炎性反应的影响

Effects of high frequency oscillatory ventilation and its combination with pulmonary surfactant treatment on inflammatory response in rabbit lung with inhalation injury

目的了解高频振荡通气（HFOV）及HFOV与肺表面活性物质（PS）联合应用对吸入性损伤家兔肺组织炎性反应的影响。方法将新西兰大白兔24只制成重度蒸气吸入性损伤模型，按随机数字表法分为对照组、HFOV组和HFOV＋Ps组，每组8只，分别行定容通气、HFOV及HFOV＋PS治疗。治疗3．5h时取各组家兔肺组织标本，行病理学检查及肺损伤评分，检测髓过氧化物酶（MPO）及半胱氨酸天冬氨酸蛋白酶1（caspase-1）活性，测定TNF—α、IL-18、IL-10和IL-13含量及其mRNA的表达情况。结果（1）各组吸入性损伤家兔肺组织出现不同程度病理学改变，以对照组最明显，HFOV＋PS组最轻。对照组、HFOV组、HFOV＋PS组肺损伤评分各为（3．71±0．43）、（2．87±0．26）、（2．08±0．28）分，组间两两比较，差异均有统计学意义（P〈0．01）。（2）HFOV组和HFOV＋PS组家兔MPO、caspase-1活性明显低于对照组（P〈0．01），并且HFOV＋PS组明显低于HFOV组（P〈0．05）。（3）HFOV组和HFOV＋PS组家兔TNF—α、IL-18含量及其mRNA表达量明显低于对照组（P〈0．01），IL-10和IL-13含量及其mRNA表达量明显高于对照组（P〈0．01）；HFOV＋PS组这几项指标较HFOV组变化更明显（P〈0．05）。结论HFOV能减轻吸入性损伤家兔肺组织炎性反应和肺损伤，联合应用PS效果更佳。

Objective To investigate the effects of high frequency oscillatory ventilation （HFOV） and its combination with administration of pulmonary surfactant （PS） on inflammatory response of lung tissue in rabbits with inhalation injury. Methods Severe steam inhalation injury models were reproduced in 24 New Zealand albino rabbits. They were divided into control group （ n = 8） , HFOV group （n = 8） , and HFOV ＋ PS group （ n = 8） according to the random number table, and they received ventilation in metered volume, HFOV, and HFOV ＋ PS treatment respectively. Lung tissue samples of rabbits were collected at 3.5 h after treatment for pathological inspection and puhnonary injury score, assay of the activity of myeloperoxidase （MPO） and cysteinyl aspartate-specific protease 1 （caspase-1）, and the determination of the contents of TNF-α, IL-18, IL-10, IL-13 and their mRNA expression. Results Pathological change in different degree of rabbit lung tissue in each group were observed, and they were most obvious in the control group, and least in the HFOV ＋ PS group. The lung tissue injury scores of control group, HFOV group, and HFOV ＋ PS group was 3.71 ± 0.43, 2.87 ±0.26, and 2.08± 0.28 respectively. The difference between either two of them were statistically significant （ P 〈 0.01 ）. The MPO content and caspase-1 activity of rabbits in HFOV and HFOV ＋ PS groups were obviously lower than those in control group （ P 〈 0. 01 ） , and MPO content and caspase-1 activity of rabbits in HFOV ＋ PS group were obviously lower than those in HFOV group （ P 〈0. 05）. In HFOV group and HFOV ＋ PS group, the contents of TNF-α, IL-18 and their mRNA expression in lung tissue homogenates were obviously lower than those in control group （ P 〈 0.01 ） ; while the contents of IL-10, IL-13 and their mRNA expression were obviously higher than those in control group （ P 〈 0.01）. Changes in these contents and expression in HFOV ＋ PS group were more obvious than those in HFOV group （ P 〈 0.05）. Conclusions HFOV can alleviate inflammatory response in rabbit lung tissue and pulmonary injury induced by inhalation injury, and the effect is more obvious when combined with PS.