盐酸戊乙奎醚联合地塞米松对兔爆震伤急性呼吸窘迫综合征的治疗作用

Therapeutic effect of penehyclidine hydrochloride combined with dexamethasone on acute respiratory distress syndrome induced by blast injury in rabbits

目的探讨盐酸戊乙奎醚(PHC)联合地塞米松(DXM)对兔胸部爆震伤ARDS的治疗作用。方法采用健康新西兰大白兔制作兔胸部爆震伤ARDS模型,将符合ARDS诊断标准的兔随机分为5组:B组,爆炸致ARDS组(n=10);C组,低剂量(0.8mg/kg)PHC组(n=9);D组,高剂量(1.5mg/kg)PHC组(n=9);E组,DXM(3mg/kg)组(n=8);F组,高剂量(1.5mg/kg)PHC+DMX(3mg/kg)组(n=7)。另取6只健康新西兰大白兔作为正常对照组(A组)。C-F组动物均于造模成功后0.5、12、24、36、48h肌注给予相应药物,A、B组动物给予等体积生理盐水。监测伤前及治疗(第一次给药)后6、24、48、72h实验动物的呼吸、心率、氧合指数及外周静脉血肿瘤坏死因子α(TNF-α)、白细胞介素(IL-6)含量;第一次给药后72h处死动物,收集支气管肺泡灌洗液(BALF),检测其中TNF-α、IL-6含量,取肺组织测定肺湿/干重比,并行HE染色观察肺组织病理变化。结果 B组呼吸、心率、肺湿/干重比及外周血和BALF中的TNF-α、IL-6含量均较A组明显升高(P<0.05),氧合指数则较A组明显降低(P<0.01)。经DXM和(或)PHC干预后,各指标均有不同程度好转,其中F组明显优于C、D、E组(P<0.05)。结论高剂量PHC联合DXM对兔爆震伤所致ARDS具有一定治疗作用,且疗效明显优于单用PHC或DXM。

Objective To discuss the therapeutic effects of penehyclidine hydrochloride combined with dexamethasone on Acute Respiratory Distress Syndrome（ARDS） after a thoracic blast injury in rabbits.Methods Healthy New Zealand white rabbits were used to establish the ARDS model induced by a thoracic blast injury.The rabbits conforming to the diagnostic standard of ARDS were divided into 5 groups randomly： B group,ARDS caused by blast（n=10）;C group,PHC（n=9） with low dose（0.8mg/kg）;D group,PHC（n=9） with higher dose（1.5mg/kg）;E group,DXM（n=8）（3mg/kg）;F group,PHC＋DMX（n=7） with higher dose（3mg/kg）.Another set of six healthy New Zealand white rabbits were used as the control group（A group）.Rabbits in the C-F group were injected with a drug at 0.5,12,24,36,and 48 h after being modeled successfully.At the same time,the rabbits in groups A and B were injected with saline in equal volumes as that in the therapeutic groups.The breathing,heart rate,and oxygenation indices,as well as the levels of TNF-α and IL-6 in the peripheral blood were monitored before the rabbits were injured,and at 6,24,48,and 72 h after medical treatments（initially given drugs）.The rabbits were sacrificed at 72 h after they were initially given drugs.Bronchoalveolar lavage fluid（BALF） was collected in which the levels of TNF-α and IL-6 were detected by ELISA.Lung tissue specimens were taken to measure the lung water content-dry weight（W/D） ratio,and hematoxylin and eosin staining was used for observing the pathological changes of the lung tissues.Results Heartbeats,breathings,W/D ratios,and contents of TNF-α,IL-6 in peripheral blood or in BALF in group B were higher than that in group A（P〈0.05）.The oxygenation index in group B was apparently lower than that in group A（P〈0.01）.All indexes increased in varying degrees after the treatments with DXM and/or PHC.Group F showed better results than groups C,D,and E（P〈0.05）.Conclusions PHC combined with DXM has a certain therapeutic effect on ARDS induced by a blast injury in rabbits,which is superior to any of the effects of PHC or DXM.