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孔 敏1 徐 淼1 和秋莉1 袁孝忠1 周煦燕1▲ 徐龙生2 杨茂宪3.俯卧位通气对海水淹溺型急性呼吸窘迫综合征大鼠的治疗作用[J].中国现代医生,2021,59(11):26-29+35
俯卧位通气对海水淹溺型急性呼吸窘迫综合征大鼠的治疗作用
Therapeutic efficacy of prone position ventilation on rats with acute respiratory distress syndrome of seawater drowning type
  
DOI:
中文关键词:  俯卧位通气  急性呼吸窘迫综合征  大鼠  海水淹溺型
英文关键词:Prone position ventilation  Acute respiratory distress syndrome  Rats  Seawater drowning type
基金项目:浙江省公益技术应用实验动物项目(LGD19 C090001);浙江省嘉兴市科技计划项目(2019AD32163;2018AY32017);浙江省嘉兴市医学重点学科-麻醉学(支撑学科)项目(2019-zc-06);浙江省嘉兴市医学重点学科-重症医学(支撑学科)项目(2019-zc-12)
作者单位
孔 敏1 徐 淼1 和秋莉1 袁孝忠1 周煦燕1▲ 徐龙生2 杨茂宪3 1.嘉兴学院附属医院麻醉科浙江嘉兴 3140012.嘉兴学院附属医院中心实验室浙江嘉兴 3140013.嘉兴学院附属医院重症医学科浙江嘉兴 314001 
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中文摘要:
      目的 探讨俯卧位通气对海水淹溺所致急性呼吸窘迫综合征大鼠的治疗作用及其机制。方法 32 只雄性SD 大鼠随机分为对照组、ARDS 组、仰卧位通气组(S 组)及俯卧位通气组(P 组),每组各8 只。通过气管内滴注海水4 mL/kg 建立ARDS 动物模型。对照组、ARDS 组2 h 后检测各指标;S 组及P 组在ARDS 建模后分别进行仰卧位或俯卧位机械通气2 h 后检测指标。检测动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、肺湿/干质量(W/D)比值;收集支气管肺泡灌洗液并测定上清液中蛋白水平;肺组织匀浆后检测髓过氧化物酶(MPO)及肿瘤坏死因子水平-α(TNF-α)。结果 与对照组比较,ARDS 组、S 组、P 组PaO2均明显降低(P<0.05);与S 相比较,P 组PaO2增高(P<0.05);与P 组比较,ARDS 组、S 组PaCO2均明显升高(P<0.05);与ARDS 组比较,S 组、P 组肺W/D 比值及BALF中总蛋白含量均明显降低(P 均<0.05);与P 组比较,S 组肺W/D 比值及BALF 中蛋白含量均明显增高(P<0.05),ARDS 组及S 组肺组织MPO 及TNF-α 显著升高(P 均<0.05);显微镜下,与S 组比较,P 组塌陷肺泡占比减少,膨胀肺泡占比减少,差异均有统计学意义(P 均<0.05)。结论 俯卧位通气可改善海水淹溺急性呼吸窘迫综合征大鼠的通气功能,减轻肺部炎症反应。
英文摘要:
      Objective To investigate the therapeutic efficacy and mechanism of prone position ventilation on rats with acute respiratory distress syndrome (ARDS) of seawater drowning type.Methods A total of 32 male SD rats were randomLy divided into the control group(n=8),the ARDS group(n=8),the supine ventilation group (the S group,n=8) and the prone ventilation group (the P group,n=8).ARDS animal model was established by intratracheal instillation of seawater with 4 mL/kg.The indexes of the control group and the ARDS group were detected after 2 hours.The indexes of the S group and the P group were detected after 2 hours of mechanical ventilation in supine or prone position after ARDS modeling,respectively.The arterial oxygen partial pressure (PaO2),carbon dioxide partial pressure (PaCO2),and lung wet/dry mass (W/D) ratio were measured.Bronchoalveolar total lavage fluid (BALF) was collected and the protein level in the supernatant was determined.The levels of myeloperoxidase (MPO) and tumor necrosis factor-α (TNF-α) in lung homogenate were detected.Results Compared with the control group,PaO2in the ARDS group,the S group and the P group decreased significantly(P<0.05).Compared with the S group,PaO2in the P group increased significantly(P<0.05),and compared with the P group,PaCO2in the ARDS group and the S group both increased significantly (P<0.05).Compared with the ARDS group,the lung W/D ratio and protein content in BALF of the S group and the P group both decreased significantly(P<0.05).Compared with the P group,the lung W/D ratio and protein content in BALF of the S group both increased significantly(P<0.05),while MPO in lung tissue and TNF-α in the ARDS group and the S group increased significantly(all P<0.05).Under microscope,compared with the S group,the proportion of collapsed alveoli and expanded alveoli in the P group decreased,all with statistically significant differences(P<0.05).Conclusion Prone position ventilation can improve the ventilation function of rats with ARDS after seawater drowning and reduce the inflammatory reaction in lungs.
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