超声引导羊膜腔内注射肺表面活性物质联合氨溴索预防早产兔肺损伤

Ultrasound guided intra-amniotic instillation of pulmonary surfactant combined with ambroxol for prevention of lung injury in preterm rabbits

目的探讨超声引导羊膜腔内注射肺表面活性物质(PS)联合应用盐酸氨溴索(AH)预防早产兔肺损伤的作用。方法将20只健康妊娠新西兰兔随机分为超声引导羊膜腔内注射PS组(PS组)、产前应用AH组(AH组)、超声引导羊膜腔内注射PS联合产前应用AH组(PS+AH组)和对照组,每组5只。于妊娠第27天羊膜腔穿刺后1 h行剖宫产术,观察各组早产兔存活时间,检测早产兔支气管肺泡灌洗液中白细胞介素6(IL-6)及二棕榈酰磷脂酰胆碱(DPPC)含量、肺组织中肺表面活性物质相关蛋白A(SP-A)含量,观察肺组织病理形态并进行肺损伤程度病理评分。结果与对照组比较,PS组、AH组和PS+AH组早产兔的存活时间延长,IL-6含量降低,DPPC及SP-A含量增加,肺损伤病理评分降低(P均<0.05),除存活时间外,其余指标PS+AH组与PS组、AH组差异均有统计学意义(P均<0.05)。结论超声引导羊膜腔内注射PS联合应用氨溴索可有效预防早产兔肺损伤。

Objective To investigate the value of ultrasound guided intra-amniotic instillation of pulmonary surfactant(PS) combined with prenatal ambroxol hydrochloride(AH) for prevention of lung injury in preterm rabbits. Methods Totally 20 pregnant New Zealand rabbits were randomly divided into 4 groups(each n=5), i.e. ultrasound guided intra-amniotic instillation of PS before cesarean section(PS group), prenatal AH(AH group), ultrasound guided intra-amniotic instillation of PS combined with prenatal AH(PS+AH group) and control group. On the 27 th day of pregnancy, rabbit fetuses were removed through cesarean section 1 hour after injection. The survival time of the preterm rabbits, the concentration of interleukin-6(IL-6) and dipalmitoyl phosphatidylcholine(DPPC) in bronchoalveolar lavage fluid, the expression level of pulmonary surfactant-associated proteins-A(SP-A) in lung tissue were detected. And the lung tissue sections were taken to observe the degree of lung injury. Results Compared with control group, the survival time of the preterm rabbits of PS group, AH group and PS+AH group prolonged, the concentration of IL-6 decreased, the concentration of DPPC and SP-A increased, and the pathological score of lung injury decreased(all P<0.05). There were significant differences between PS+AH group and PS, AH group in those indexes except for survival time(all P<0.05). Conclusion Ultrasound guided intra-amniotic instillation of PS combined with prenatal AH plays a role in the prevention of lung injury in preterm rabbits.