机械通气方式对新生猪支气管肺泡灌洗液炎性因子及肺表面活性物质相关蛋白A的影响

Effects of mechanical ventilation method on inflammatory factors and pulmonary surfactant associated protein A of bronchoalveolar lavage fluid in newborn piglets with acute lung injury

目的观察常频机械通气（CMV）、高频振荡通气（HFOV）、部分液体通气（PLV）3种机械通气方式对急性肺损伤（ALI）新生猪BALF炎性因子及肺表面活性物质相关蛋白A（SP—A）水平的影响。方法出生1～3d健康新生猪24只，用9g／L盐水（38℃，35mL／kg）灌洗制备ALI模型。随机分为4组：对照组（6只，模型制备成功后不予通气，直接处死）、CMV组（6只）、HFOV组（6只）、PLV组（6只），行机械通气24h后处死动物，用ELISA法检测BALF中TNF-α、IL-8、IL-1及sP—A水平。结果3种方式机械通气24h后，BALF中3种炎性因子及SP—A总体均数比较差异均有统计学意义（P均=0．000），PLV组、HFOV组sP-A水平较CMV组高（P均〈0．05），PLV组IL培、IL-1、TNF-α水平较CMV组低（P均〈0．05），PLV组IL-8、TNF-α水平较HFOV组低（P均〈0．05），HFOV组IL-8、TNF-α水平较CMV组低（P均〈0．05）。结论不同机械通气方式致肺部炎性反应不同，PLV致肺部炎性反应最轻。PLV较CMV、HFOV更能增加SP—A表达，降低SP—A的降解。

Objective To investigate the effects of 3 different ventilation methods,including conventional me- chanical ventilation （CMV）, high frequency oscillatory ventilation（ HFOV ）and partial liquid ventilation （PLV）, on the changes of inflammatory factors and pulmonary surfactant associated protein A （ SP-A ） in bronchoalveolar lavage fluid （BALF） in newborn piglets with acute lung injury （ALI）. Methods Twenty-four newborn piglets, no more than 3 days old,were enrolled. After ALI made with saline lavage （38 ℃ ,35 mL/kg） , newborn piglets were randomly assigned to 4 groups ： control group （ n = 6, no ventilation）, CMV group （ n = 6 ）, HFOV group （ n = 6 ）, and PLV group （ n = 6 ）. Piglets were sacrificed after being ventilated for 24 h. Tumor necrosis factor-α （ TNF-α）, interleukin-8 （ IL-8 ） , interleukin-1 （ IL- l ） and SP-A in BALF were measured quantitatively by using enzyme-linked immunosorbent assay. Results In 3 groups using different ventilation methods, the population mean of TNF-α, IL-8, IL-1 and SP-A were statistically diffe- rent（ all P = 0. 000 ）. SP-A in PLV group and HFOV group were higher than that in CMV group （all P 〈 0.05 ）, while IL-8, IL-1 and TNF-α in PLV group were lower than those in CMV group （ all P 〈 0.05 ）, IL-8 and TNF-α in PLV group were lower than those in HFOV group （ all P 〈 0.05 ）, IL-8 and TNF-α in HFOV group were lower than those in CMV group （ all P 〈 0.05 ）. Conclusions Pulmonary inflammatory reaction was different in 3 ventilation groups. Com- pared with CMV and HFOV, PLV attenuated inflammatory reaction, so it could increase the expression of SP-A and de- crease the degradation of SP-A.