不同时程深度急性高容血液稀释对兔急性肺损伤的影响

Effects of different durations of severe acute hypervolemic hemodilution on acute lung injury in rabbits

目的 评价不同时程深度急性高容血液稀释（AHH）对兔急性肺损伤的影响.方法 健康成年家兔36只,体重2.7～3.1 kg,雌雄不拘,采用随机数字表法,将其分为2组（n=18）：对照组（C组）和AHH组.AHH组静脉输注6％羟乙基淀粉130/0.4行AHH,目标Hct为20％.于AHH前即刻（T0）、AHH后1 h（T1）、2 h（T2）和4h（T3）时,采集右股动脉血样行血气分析,计算氧合指数,记录急性肺损伤（氧合指数≤300 mmHg）的发生情况.于T1-3时采集血样后,每组处死6只兔,取肺组织,测定湿重/干重比值,并采用免疫组化法检测水通道蛋白-1表达.结果 AHH组AHH后1～2h有1只家兔发生急性肺损伤,AHH后2～4h有4只家兔发生急性肺损伤.与C组比较,AHH组T1-3时湿重/干重比值升高,T23时肺组织水通道蛋白-1表达降低（P＜0.05或0.01）.结论 6％羟乙基淀粉130/0.4进行深度AHH,目标Hct 20％,时程＞1h时,兔发生急性肺损伤.

Objective To evaluate the effects of different durations of severe acute hypervolemic hemodilution （AHH） on acute lung injury in rabbits.Methods Thirty-six healthy adult rabbits of both sexes, weighing 2.7-3.1 kg, were randomly divided into 2 groups （n=18 each） using a random number table： control group （C group） and AHH group.AHH was performed with 6% hydroxyethyl starch 130/0.4 until the target hematocrit of 20% was achieved in group AHH.Immediately before AHH （T0） , and at 1,2 and 4 h after AHH （T1-3） , blood samples were taken from the right femoral artery for blood gas analysis.The oxygenation index was calculated.The occurrence of acute lung injury （oxygenation index ≤ 300 mm-Hg） was recorded.After blood samples were collected at T1-3 , 6 rabbits in each group were sacrificed, and lungs were removed for determination of wet/dry lung weight ratio （W/D ratio） and aquaporin-1 （AQP-1） expression （by immuno-histochemistry）.Results In group AHH, 1 rabbit developed acute lung injury at 1-2 h after AHH, and 4 rabbits developed acute lung injury at 2-4 h after AHH.Compared with group C,W/D ratio was significantly increased at T1-3, and the expression of AQP-1 was down-regulated at T2,3 in group AHH （P〈0.05 or 0.01）.Conclusion Severe AHH performed with 6% hydroxyethyl starch 130/ 0.4 with the target hematocrit reduced to 20% and the duration 〉 1 h induces acute lung injury in rabbits.