肺复张策略对肺内、外源性损伤大鼠模型的肺保护作用

Protective effect of lung recruitment maneuver in rats model of pulmonary and extra-pulmonary origin ALI

目的探讨肺复张策略对肺内、外源性损伤大鼠模型的肺保护作用。方法清洁级SD大鼠60只,雌雄各半,随机均分为6组;空白对照组(K组)、肺复张对照组(F组)、肺内源性损伤组(AN组)、肺复张内源性损伤组(RN组)、肺外源性损伤组(AW组)、肺复张外源性损伤组(RW组)。采用逐步提高压力的控制性膨肺的肺复张策略。机械通气4 h后,使用酶联免疫分析法(ELISA法)检测大鼠肺泡灌洗液(BALF)中Fas、TNF-α、SP-A的浓度及肺损伤Smith评分。结果 BALF中的Fas、TNF-α、SP-A浓度:与AN组比较,RN组Fas和TNF-α水平较低,SP-A水平较高(P<0.05);与AW组比较,RW组的Fas和TNF-α水平较低,SP-A水平较高(P<0.05);与RN组比较,RW组的Fas和TNF-α水平低,SP-A水平较高(P<0.05)。肺损伤评分,RN组和RW组肺损伤评分低于AN组和AW组,且RW组低于RN组(P<0.05)。结论肺复张策略可以减轻肺组织病理损伤,增加肺内SP-A水平并降低Fas和TNF-α水平;对肺内、外源性损伤大鼠模型具有肺保护作用。肺复张策略对肺外源性急性肺损伤的疗效优于肺内源性急性肺损伤。

Objective To investigate the protective effect of lung recruitment maneuver in rat with acute lung injury on pulmonary and extra-pulmonary origin .Methods 60 male and female SD rats were randomly divided into 6 groups （n=10 each）：the control group （K group）, the lung recruitment control group （F group）, the pulmonary injury group （AN group）, the lung recruitment maneuvers pulmonary injury group （RN group）, the extra-pulmonary injury group （ AW group ） , and the lung recruitment maneuvers extra-pulmonary injury group （ RW group ） .The pressure sustained inflation was gradually increased .4 hours after mechanical ventilation , their lung injury was evalu-ated by Smith lung injury score , and the levels of SP-A, Fas and TNF-αin bronchoalveolar lavage fluid （ BALF） were measured by enzyme-linked immunosorbent assay （ ELISA） .Results Compared with the group AN , AW and RN, the levels of serum Fas and TNF-a decreased and serum SP-A increased in the group RN , RW and RW （ P〈0.05） .Compared with the group RW and RN , Smith lung injury score increased in the group AW and AN （ P〈0.05）.Conclusion Lung recruitment maneuver can alleviate lung injury , increase serum SP-A concentration and decrease erum Fas and TNF-a, and it also has the protective effect for pulmonary and extra-pulmonary origin ALI , which is better for extra-pulmonary injury than that for pulmonary injury .