气腹模型中预气腹与谷氨酰胺干预对肺损伤保护作用的研究

The Protective Effects of Laparoscopic Preconditioning Pneumoperitoneum and Glutamine on Laparoscopy-induced Lung Injury in Rabbits

目的探讨3 h的家兔气腹模型是否造成肺损伤,以及气腹预处理与谷氨酰胺干预对肺损伤的保护作用。方法实验家兔随机分为4组,对照组(D组)建立气腹3 h,预气腹组(A组)在3 h的气腹前给予5 min的预气腹处理,谷氨酰胺组(B组)在建立气腹前静脉注射谷氨酰胺,C组在谷氨酰胺干预后再进行气腹预处理及3 h的气腹。各组均在解除气腹后20 min取血液测定血浆蛋白浓度,收集支气管肺泡灌洗液(BALF),离心后测定上清液蛋白含量及下层沉淀液白细胞(WBC)计数,称取部分肺组织测定髓过氧化物酶(MPO)活性及湿、干质量,计算肺组织含水量、肺通透指数(LPI)。结果 A、B、C 3组的肺组织含水量、LPI、支气管肺BALF中WBC计数、肺组织MPO活力等指标均小于D组,差异有统计学意义(P<0.05),而A、B、C 3组间各指标的差异均无统计学意义(P>0.05)。结论较长时间(3 h)气腹造成了肺损伤,预气腹与谷氨酰胺干预可以一定程度保护肺组织减轻损伤,但同时采用预气腹与谷氨酰胺干预无叠加的肺保护作用。

Objective To study whether pneumoperitoneum which lasts for 3 hours can induce lung injury,and to evaluate the protective effects of laparoscopic preconditioning and glutamine on laparoscopy-induced lung injury.Methods 33 rabbits were randomly assigned to following groups.The control group（C）was subjected to pneumoperitoneum lasted for 3 hours.The laparoscopic preconditioning group（A）was subjected to 5 minutes of insufflation and 5 minutes of desufflation followed by 3 hours of pneumoperitoneum.The group B was subjected to 3 hours of pneumoperitoneum with glutamine injected intravenously before pneumoperitoneum.The group A and B were subjected to glutamine injected intravenously followed by laparoscopic preconditioning then 3 hours of pneumoperitoneum.After 20 minutes of desufflation subsequent to cessation of pneumoperitoneum,blood,lung,and bronchoalveolar lavage fluid（BALF）samples were obtained from every rabbit of the groups.White blood cell（WBC） count in BALF were determined.The myleopemxidase（MPO）activity,wet to dry weight ratio（W/D） and lung water content were also measured.Results Lung tissue MPO activity,lung permeability index（LPI）,wet to dry weight ratio（W/D） and WBC count of BALF in group C were higher than those in the other groups（P0.05）.There was no difference between group A and B,group A and D,group B and D for the above data（P0.05）.Conclusion Pneumoperitoneum for a relatively long time（3 hours）can induce lung injury.Laparoscopic preconditioning and glutamine have obviously protective effects,but it＇s no was no additive effect for laparoscopic preconditioning plus glutamine.