脂肪乳联合血液灌流透析对急性百草枯中毒犬肺损伤的疗效研究

Analysis of therapeutic effect of lipid emulsion combined with hemoperfusion and hemofiltration on acute paraquat poisoning and acute lung injury in dogs

目的探讨脂肪乳联合血液灌流透析对急性百草枯中毒的疗效及其对中毒所致急性肺损伤的治疗作用。方法取健康杂种犬24只,随机分为A、B、C、D 4组,予以肌肉注射30 mg·kg-1百草枯进行染毒,注射过程中无药物损失即为染毒成功。A组予以4 m L·kg-10.9%氯化钠,静脉注射速度0.5m L·kg-1·h-1;B组予以4 m L·kg-120%脂肪乳,以0.5 m L·kg-1·h-1静脉注射速度输注10 min;C组予以静脉注射4 m L·kg-10.9%氯化钠后开始血液灌流48 h;D组予以静脉注射4 m L·kg-120%脂肪乳后开始血液灌流48 h。分别于血液灌流开始后0,8,12,24,36,48 h检测血清中肿瘤坏死因子-α(TNF-α)、白细胞介素1β(IL-1β)、IL-10、胰岛素样生长因子-1(IGF-1)、转化生长因子-β1(TGF-β1)变化。结果治疗24 h后,A组TNF-α、IL-1β、IL-10、IGF-1、TGF-β1明显高于B、C、D组(P<0.05)。治疗12 h后,D组TNF-α、IL-1β、IL-10、IGF-1、TGF-β1水平的降低,且治疗结束后TNF-α、IL-1β、IL-10、IGF-1、TGF-β1水平较B组显著下降(P<0.05)。结论脂肪乳联合血液灌流可以减轻急性百草枯中毒导致的肺损伤。

Objective To explore the therapeutic effect of lipid emulsion combined with hemoperfusion and hemofiltration on acute paraquat poisoning and its consequence of acute lung injury. Methods A total of24 dogs were randomly divided into A,B,C,D group. After paraquat（ PQ） 30 mg·kg^-1 was given by intramuscular injection,if there was no loss during the injection process,the model of poisoning was considered to be made successfully. Then the dog models in four groups were respectively treated with 4 mL·kg^- 1 0. 9% Na Cl intravenous injection in group A,4 mL · kg^- 1lipid emulsion intravenous injection in group B,4 mL·kg^- 1 0. 9% Na Cl intravenous injection combined with hemoperfusion and hemofiltration in group C,and 4 mL·kg^- 1 lipid emulsion combined with hemoperfusion and hemofiltration in group D. The standards of tumor necrosis factor- α（ TNF- α）,interleukin- 1β（ IL- 1β）,IL- 10,human insulin like growth factor- 1（ IGF- 1）,transforming growth factor- 1（ TGF- β1） were determined at 0,8,12,24,36 and48 h after starting the hemoperfusion and hemofiltration. Results Every index TNF- α,IL- 1β,IL- 10,IGF- 1,TGF- β1of the group A was significantly higher than that in the group B,C,D at the same section（ P〈0. 05）. In group B,the cytokine levels TNF- α,IL- 1β,IL- 10,IGF- 1,TGF- β1were significantly higher compared with group D（ P〈0. 05）. Conclusion Lipid emulsion combined with hemoperfusion and hemofiltration can be beneficial to relieve the lung injury induced by acute paraquat poisoning.