俯卧位通气对肺内源性急性肺损伤大鼠的影响

doi:10.3877/cma.j.issn.1674-6880.2016.01.002

中华危重症医学杂志(电子版) ›› 2016, Vol. 09 ›› Issue (01) : 9 -13. doi: 10.3877/cma.j.issn.1674-6880.2016.01.002

所属专题：文献；

论著

俯卧位通气对肺内源性急性肺损伤大鼠的影响

杨茂宪¹, 施云超¹, 朱建刚¹, 沈鹏¹, 王海波¹, 宋先斌¹, 许鹏程², 赵文静²^,^†(

)

^1. 314001　浙江嘉兴，浙江省嘉兴市第一医院ICU
^2. 221002　江苏徐州，徐州医学院江苏省麻醉学重点实验室；221002　江苏徐州，徐州医学院附属医院ICU

收稿日期:2015-06-16 出版日期:2016-02-01
通信作者: 赵文静
基金资助:
江苏省六大人才高峰基金资助计划(2009059); 嘉兴市医学重点学科重症医学基金资助项目(04-Z-08); 嘉兴市医学重点学科（支撑学科）资助项目(04-Z-08)

Effects of prone ventilation in rats with pulmonary acute lung injury

Maoxian Yang¹, Yunchao Shi¹, Jiangang Zhu¹, Peng Shen¹, Haibo Wang¹, Xianbin Song¹, Pengcheng Xu², Wenjing Zhao²^,^†()

^1. Department of Intensive Care Unit, the First Hospital of Jiaxing, Jiaxing 314001, China
^2. Jiangsu Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou 221002, China; Department of Intensive Care Unit, the Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China

Received:2015-06-16 Published:2016-02-01
Corresponding author: Wenjing Zhao
About author:
Corresponding author: Zhao Wenjing, Email: zhaowj886@sina.com

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杨茂宪, 施云超, 朱建刚, 沈鹏, 王海波, 宋先斌, 许鹏程, 赵文静. 俯卧位通气对肺内源性急性肺损伤大鼠的影响[J]. 中华危重症医学杂志(电子版), 2016, 09(01): 9-13.

Maoxian Yang, Yunchao Shi, Jiangang Zhu, Peng Shen, Haibo Wang, Xianbin Song, Pengcheng Xu, Wenjing Zhao. Effects of prone ventilation in rats with pulmonary acute lung injury[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2016, 09(01): 9-13.

目的

探讨俯卧位通气对脂多糖（LPS）诱导的肺内源性急性肺损伤（ALI）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、ALI组、ALI仰卧位通气组（ALIS组）及ALI俯卧位通气组（ALIP组），每组各8只。通过气管内滴注LPS 6 mg/kg建立ALI动物模型，24 h后ALIS组及ALIP组分别实施仰卧位或俯卧位通气4 h。之后观察动脉血氧分压（PaO₂）、二氧化碳分压（PaCO₂）、肺组织湿/干重比（W/D）；比较血清中肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）水平；光镜下观察肺组织病理形态学变化。

结果

与对照组比较，ALI组、ALIS组和ALIP组PaO₂明显降低（F = 57.369，P < 0.001），ALI组、ALIS组PaCO₂均明显升高（F = 8.448，P < 0.001），ALI组、ALIS组和ALIP组肺W/D及血清中TNF-α、IL-6均明显升高（F = 13.609、6.443、23.849，P = 0.001、0.017、< 0.001）；与ALI组比较，ALIS组和ALIP组PaO₂明显升高，PaCO₂、肺W/D比值、血清中TNF-α、IL-6均明显降低（P均< 0.05）。与ALIS组相比，ALIP组PaO₂升高[（83 ± 6）mmHg vs.（71 ± 5）mmHg，P < 0.05]，PaCO₂降低[（50 ± 7）mmHg vs.（58 ± 6）mmHg，P < 0.05]，肺组织W/D比值降低[（4.65 ± 0.56）vs.（4.82 ± 0.41），P < 0.05]及TNF-α、IL-6在血清中的水平均降低[（293 ± 68）ng/L vs.（366 ± 44）ng/L；（358 ± 39）ng/L vs.（440 ± 38）ng/L，P均< 0.05]。同时肺组织病理形态学显示，与ALIS组相比，ALIP组腹侧过度膨胀区域减少（F = 63.423，P < 0.001），正常通气区域增加（F = 73.229，P < 0.001）；ALIP组背侧塌陷区域减少（F = 68.586，P < 0.001），正常通气区域及过度膨胀区域增加（F = 61.871，P < 0.001；F = 9.800，P = 0.001）。

结论

俯卧位通气能促进LPS诱导的肺内源性ALI大鼠的气体交换，减轻肺水肿，降低炎症反应。

关键词: 俯卧位通气, 急性肺损伤, 脂多糖类, 大鼠，Sprague-Dawley

Objective

To investigate the effects of prone ventilation in rats with lipopolysaccharide (LPS) induced pulmonary acute lung injury (ALI).

Methods

Totally 32 male Sprague-Dawley rats were randomly divided into four groups, 8 rats in each group: control group, pulmonary ALI group, supine position group (ALIS) and prone position group (ALIP). Rats in the ALI, ALIS, and ALIP groups were given 6 mg/kg LPS intratracheally to build the ALI rat model. After 24 h, rats in the ALIS and ALIP groups were were mechanically ventilated for 4 h in supine or prone positions. After that, PaO₂ and PaCO₂ of arterial blood, lung tissue wet/dry weight ratio (W/D), tumour necrosis factor-alpha (TNF-α) and interleukin-6(IL-6) concentrations in serum were compared in these four groups, and lung tissue morphometric analysis was inverstigated under light microscope at the same time.

Results

Compared with the control group, PaO₂ were significantly lower in the ALI, ALIS and ALIP groups (F = 57.369, P < 0.001); PaCO₂ in the ALI and ALIS groups were obviously higher (F = 8.448, P < 0.001); lung tissue W/D ratio, as well as the levels of TNF-α and IL-6 in serum were significantly higher in the ALI, ALIS and ALIP groups (F = 13.609, 6.443, 23.849; P = 0.001, 0.017, < 0.001). Compared with the ALI group, PaO₂ in the ALIS and ALIP groups was significantly higher, but lung tissue W/D ratio, TNF-α and IL-6 in serum were obviously lower in these two groups (all P< 0.05). Compared with the ALIS group, except PaO₂ was higher [(83 ± 6) mmHg vs. (71 ± 5) mmHg], PaCO₂ [(50 ± 7) mmHg vs. (58 ± 6) mmHg, P < 0.05], lung tissue W/D ratio [(4.65 ± 0.56) vs. (4.82 ± 0.41), P < 0.05, TNF-α and IL-6 in serum [(293 ± 68) ng/L vs. (366 ± 44) ng/L; (358 ± 39) ng/L vs. (440 ± 38) ng/L; all P < 0.05] were obviously lower in the ALIP group. Meanwhile under light microscope, compared with the ALIS group, hyper-inflated areas were less (F = 63.423, P < 0.001), normal areas were larger (F = 73.229, P < 0.001) on the ventral side in the ALIP group. Also, normal and hyper-inflated area were greater (F = 61.871, P < 0.001; F = 9.800; P = 0.001) when the collapsed area was less (F = 68.586, P < 0.001) on the dorsal side in the ALIP group.

Conclusion

In LPS-induced pulmonary ALI rats model, the prone ventilation improved gas exchange, decreased pulmonary edema with attenuate inflammatory responses.

Key words: Prone ventilation, Acute lung injury, Lipopolysaccharides, Rat, Sprague-Dawley

表1 俯卧位通气对ALI大鼠PaO₂、PaCO₂、肺W/D比值及血清中TNF-α、IL-6含量的影响（±s）

组别	例数	PaO₂(mmHg)	PaCO₂(mmHg)	肺组织W/D	血清TNF-α(ng/L)	血清IL-6(ng/L)
对照组	8	115 ± 9	43 ± 6	4.43 ± 0.18	206 ± 18	116 ± 27
ALI组	8	57 ± 4^a	58 ± 6^a	5.06 ± 0.49^a	443 ± 49^a	645 ± 78^a
ALIS组	8	71 ± 5^ab	50 ± 7^ab	4.82 ± 0.41^ab	366 ± 44^ab	440 ± 38^ab
ALIP组	8	83 ± 6^abc	42 ± 6^bc	4.65 ± 0.56^abc	293 ± 68^abc	358 ± 39^abc
F值	?	57.369	8.448	13.609	6.443	23.849
P值	?	< 0.001	< 0.001	0.001	0.017	< 0.001

表1 俯卧位通气对ALI大鼠PaO₂、PaCO₂、肺W/D比值及血清中TNF-α、IL-6含量的影响（±s）

组别	例数	PaO₂(mmHg)	PaCO₂(mmHg)	肺组织W/D	血清TNF-α(ng/L)	血清IL-6(ng/L)
对照组	8	115 ± 9	43 ± 6	4.43 ± 0.18	206 ± 18	116 ± 27
ALI组	8	57 ± 4^a	58 ± 6^a	5.06 ± 0.49^a	443 ± 49^a	645 ± 78^a
ALIS组	8	71 ± 5^ab	50 ± 7^ab	4.82 ± 0.41^ab	366 ± 44^ab	440 ± 38^ab
ALIP组	8	83 ± 6^abc	42 ± 6^bc	4.65 ± 0.56^abc	293 ± 68^abc	358 ± 39^abc
F值	?	57.369	8.448	13.609	6.443	23.849
P值	?	< 0.001	< 0.001	0.001	0.017	< 0.001

表2 俯卧位通气对ALI大鼠腹侧及背侧区域肺组织病理形态学的影响（±s）

组别	例数	背侧区域			腹侧区域
组别	例数	正常肺泡(%)	塌陷肺泡(%)	过度膨胀肺泡(%)	正常肺泡(%)	塌陷肺泡(%)	过度膨胀肺泡(%)
对照组	8	96.6 ± 2.3	3.4 ± 2.3	0.0 ± 0.0	94.1 ± 2.0	5.9 ± 2.0	0.0 ± 0.0
ALI组	8	64.6 ± 4.7^a	35.4 ± 4.7^a	0.0 ± 0.0	60.3 ± 5.6^a	39.7 ± 5.6^a	0.0 ± 0.0
ALIS组	8	59.2 ± 4.8^ab	39.9 ± 4.9^ab	0.9 ± 0.6^ab	65.9 ± 7.0^ab	21.9 ± 5.9^ab	12.2 ± 3.4^ab
ALIP组	8	72.9 ± 4.7^abc	25.5 ± 5.0^abc	1.6 ± 1.1^abc	74.6 ± 3.5^bc	25.4 ± 3.5^ab	0.0 ± 0.0^c
F值	?	61.871	68.586	9.800	73.229	23.315	63.423
P值	?	< 0.001	< 0.001	0.001	< 0.001	< 0.001	< 0.001

表2 俯卧位通气对ALI大鼠腹侧及背侧区域肺组织病理形态学的影响（±s）

组别	例数	背侧区域			腹侧区域
组别	例数	正常肺泡(%)	塌陷肺泡(%)	过度膨胀肺泡(%)	正常肺泡(%)	塌陷肺泡(%)	过度膨胀肺泡(%)
对照组	8	96.6 ± 2.3	3.4 ± 2.3	0.0 ± 0.0	94.1 ± 2.0	5.9 ± 2.0	0.0 ± 0.0
ALI组	8	64.6 ± 4.7^a	35.4 ± 4.7^a	0.0 ± 0.0	60.3 ± 5.6^a	39.7 ± 5.6^a	0.0 ± 0.0
ALIS组	8	59.2 ± 4.8^ab	39.9 ± 4.9^ab	0.9 ± 0.6^ab	65.9 ± 7.0^ab	21.9 ± 5.9^ab	12.2 ± 3.4^ab
ALIP组	8	72.9 ± 4.7^abc	25.5 ± 5.0^abc	1.6 ± 1.1^abc	74.6 ± 3.5^bc	25.4 ± 3.5^ab	0.0 ± 0.0^c
F值	?	61.871	68.586	9.800	73.229	23.315	63.423
P值	?	< 0.001	< 0.001	0.001	< 0.001	< 0.001	< 0.001

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