早期液体复苏联合2%氢气吸入对LPS致脓毒性休克大鼠肺损伤的保护作用

Protective effect on lung injury by early goal directed liquid resuscitation plus hydrogen inhalation in septic shock rat model

目的:研究脓毒性休克致ALI过程中氧自由基损伤情况,评价早期液体复苏和2%氢气吸入干预对肺损伤的影响。方法:LPS静脉注射建立脓毒性休克大鼠模型,随机分成4组:正常对照组(C),脓毒性休克对照组(S),早期液体复苏组(R),早期液体复苏+2%氢气吸入组(R+H2)。C组、S组、R组吸入气为空气,R+H2组吸入气为2%氢空混合气,其余机械通气参数相同,R组和R+H2组给与相同的液体复苏方案,维持平均动脉压于正常水平,记录各组生命体征及补液量。实验结束时各组采集动脉血行血气分析,采集肺组织标本检测肺W/D值,羟自由基、丙二醛(MDA)、超氧化物岐化酶(SOD)及髓过氧化物酶(MPO)活力,光镜下观察肺组织病理改变。统计学组间比较采用t检验。结果:脓毒性休克致急性肺损伤过程中氧化损伤严重;R+H2组补液量及去甲肾上腺素用量明显低于R组(P<0.05),使W/D值明显降低,氧和指数改善,羟自由基、MDA、及MPO活力降低,SOD活力升高(P<0.05);H.E染色结果进一步提示R+H2组肺损伤程度较R组明显改善。结论:脓毒性休克致急性肺损伤过程中存在严重氧自由基损伤,早期液体复苏联合2%氢气吸入既保证了有效的血流动力学,又减少了补液量,降低了氧自由基损伤,从而减轻了肺损伤程度。

Objective To assess the protective effect of early liquid resuscitation plus 2%hydrogen inhalation on septic shock rat model reduced by LPS injection.Methods Rats were anesthetized,mechanically ventilated,paralyzed and instrumented to measure mean arterial pressure and heart rate.And then they were randomly divided into groups：control group（C） ,septic shock group（S） ,liquid resuscitation group（R） ,liquid resuscitation plus 2% hydrogen inhalation group（R＋H2） .Except the inhalation gas,the ventilation parameters were the same in the four groups. Inhalation gas was 2% hydrogen and air mixture in R＋H2 group and the others were only air.R and R＋H2 group were treated with the same liquid plan to maintain the mean artery pressure.At the end of experiment,artery blood and the lung were collected for blood gas analysis and to test the activity of hydroxyl radical,MDA,MPO,SOD and W/D ratio of lung.Pathology assessment of lung was done under light bioscope.Results There were severe oxidation damage on lung during septic shock.The usage of saline and noradrenalin in R＋H2 group was fewer than that in R group（P 0.05） .The activity of hydroxyl radical,MDA and MPO was decreased in R＋H2 group compared with R group.And the activity of SOD was increased in R＋H2 group.Lung injuries were less serious in R＋H2 group than R group by HE.Conclusion Active oxygen free radicals deteriorate lung injuries in septic shock group.Early liquid resuscitation plus 2% hydrogen inhalation can not only maintain effective hemodynamics with less liquid infusion,but also can reduce lung injuries by active oxygen free radicals.