| 摘要: |
| 目的通过观察连续血液净化治疗对内毒素诱导急性呼吸窘迫综合征（ARDS）猪的呼吸力学、血流动力学、炎症因子及心、肺、肾的病理组织学和NF-κB蛋白含量的影响，探讨其对ARDS猪的治疗作用。方法12只健康雄性猪按照随机数字法分为实验组和对照组，每组6只，采用静脉注射内毒素（20滋g/kg）制备ARDS猪模型，造模成功后，给予常规镇痛、镇静、血流动力学监测、呼吸机辅助通气等治疗；实验组常规支持治疗的同时，给予连续性静脉-静脉血液滤过治疗。观察并记录Ba、0、2、4、6h两组动态肺顺应性（Cdyn）、氧合指数（PaO2/FiO2）、血流动力学、每小时尿量等变化，ELISA法测定血清及支气管肺泡灌洗液的TNF-α、IL-6、IL-10水平。6h后处死猪取心、肺、肾组织，观察组织形态学的改变，Westernblot检测组织NF-κBp65蛋白含量。结果实验组6hCdyn、PaO2/FiO2均优于对照组（均P＜0.05）；实验组4、6h心率减慢、平均动脉压（MAP）升高、血管外肺水指数减少（P＜0.05）；实验组心指数、6h时尿量优于对照组（均P＜0.05）；实验组6h时血清TNF-α、IL-10水平均低于对照组，实验组4、6h时IL-6水平均低对照组（均P＜0.05）。实验组6h时支气管肺泡灌洗液IL-6、TNF-α水平均低于对照组（均P＜0.05）。实验组心、肺、肾组织结构均损伤轻，炎症细胞浸润不明显;对照组肺泡间隔增宽，纤维组织增生，散在淋巴细胞、浆细胞及中性粒细胞浸润，肾小球少许瘀血，小灶坏死，心肌间质散在淋巴细胞、浆细胞浸润。结论连续血液净化治疗对内毒素诱导的ARDS猪器官有一定的保护作用。 |
| 关键词: 急性呼吸窘迫综合征 连续血液净化治疗 猪 器官保护 |
| DOI： |
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| 基金项目:浙江省医药卫生科学研究基金 |
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| Continuous blood purification in treatment for LPS-induced acute respiratory distress syndrome in pigs |
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JIANG Yongpo, LIN Ronghai, XU Yinghe, YU Fangyu, ZHU Min, CUI Ke, LI Aiqin, YANG Weiying
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Taizhou Hospital
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| Abstract: |
| Objective To evaluate the effect of continuous veno-venous hemofiltration (CVVH) on LPS-induced acute respiratory distress syndrome (ARDS) in pigs. Methods Twelve male pigs were randomly divided into control group (n=6) and treatment group (n=6). ARDS was induced by injection of endotoxin 20滋g/kg. After the ARDS was induced, all animals received analgesic and sedation; then were mechanically ventilated. The animals in control group received supportive treatment and the animals in treatment group received CVVH. The dynamic compliance(Cdyn), blood oxygen partial pressure/inhale oxygen volume fraction (PaO2/FiO2) and hemodynamics were measured, the volume of urine was recorded at baseline, 0h, 2h, 4h and 6h after ARDS induced. The levels of TNF-α, IL-6 and IL-10 in serum and bronchoalveolar lavage fluid (BALF) were measured by ELISA. The histology of heart, lung and kidney were examined after animals were sacrificed. The expression of NF-κB in tissue was detected by Western blot. Results There were significant differences in dCdyn, PaO2/FiO2 between two groups at 6h after ARDS induced (P＜0.05). The heart rate was decreased, mean arterial pressure was increased, extravascular lung water index was reduced in animals of treatment group at 4h and 6h after ARDS induced (P＜0.05). Compared to control group the cardiac index(CI) and the amount of urine in treatment group at 6h was significantly lower(P＜0.05). Compared to control group the serum TNF-α and IL-10 levels at 6h and IL-6 level at 4h and 6h in treatment group were significantly lower (P＜0.05). Compared to control group the inflammation markers TNF-α and IL-6 in BALF at 6h in treatment group was significantly lower (P＜0.05). Histopathological examination showed that there were alveolar septum broadening or fiber hyperplasia and inflammatory infiltration in issues; glomerular congestion, small focal necrosis, lymphocytes and plasma cells scattered in myocardial interstitial were observed in control group; while there was alveolar septum slightly broadening and less lymphocytic infiltrates in treatment group; heart and kidney were normal. Conclusion The results indicate that continuous blood purification therapy has an organ protective effect for LPS-induced ARDS pig. |
| Key words: Acute respiratory distress syndrome (ARDS) Continuous blood Purifieatio Pigs Organ protection |
