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低温对肠缺血再灌注所致急性肺损伤保护作用的实验研究
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摘要
目的:研究低温对肠缺血再灌注所致急性肺损伤的保护作用和可能机制。
     方法:新西兰大耳白兔108只,随机分为空白对照组(肛温37~38℃,假手术组)、缺血对照组(肛温37~38℃)、浅低温组(肛温32~35℃)、中低温组(肛温28~31.9℃)、延迟浅低温组(肛温32~35℃)和延迟中低温组(肛温28~31.9℃),每组18只。实验组采用完全夹闭肠系膜上动脉1小时,开放后再灌注的方法制备肠缺血再灌注(Intestine Ischemia Reperfusion,ⅡR)致急性肺损伤(acutelung iniury,ALI)模型。采用体表降温的方法控制实验动物体温。实验过程中监测动物心率、平均动脉压、呼吸频率、动脉血气分析;再灌注前、后2、4、6小时行血TNF、IL-1、IL-6、IL-10浓度检测;再灌注6小时行血PT、SP-A和BALF中TNF、IL-1、IL-6、IL-10、SP-A浓度检测;再灌注6小时每组随机选取8只动物取肺组织标本,行光镜病理检查和肺组织湿/干比值、MPO、MDA、SOD、ATP酶和乳酸浓度检测;其余每组10只动物观察24小时存活情况。
     结果:实验组动物出现肠缺血再灌注所致急性肺损伤。和空白对照组比较,实验组的PaO_2降低,血液中TNF、IL-1、IL-6、IL-10和SP-A水平升高,BALF中TNF、IL-1、IL-6、IL-10水甲升高,SP-A水平降低;肺组织肺水增加,MPO、MDA水甲升高,SOD、ATP酶活性降低,乳酸浓度升高;光镜下观察存在肺损伤证据。在实施低温治疗后,同缺血对照组相比,上述肺损伤的表现得到了改善,同时发现浅低温同中低温的治疗效果类似,但对于循环、呼吸和凝血功能的影响小于中低温;延迟的低温治疗在一定程度上也改善了肠缺血再灌注造成的肺损伤。
     结论:(1)本研究在兔模型上模拟肠缺血再灌注导致了急性肺损伤;(2)浅低温和中低温可以有效改善肠缺血再灌注导致急性肺损伤动物模型的早期炎症反应和低氧血症、降低代谢水平和提高抗氧化能力,减轻肺组织损伤的程度;(3)低温和中低温对肠缺血再灌注导致急性肺损伤早期治疗应用是安全的,浅低温效果同中低温类似,并可能存活时间更长,但对实验动物的循环、呼吸和凝血功能的影响更小,应用更安全。(4)肠道缺血再灌注后应早期使用低温,但延迟开始的低温对肠道缺血再灌注所致急性肺损伤也有一定的治疗作用。
Objective: To study of hypothermia in the treatment of acute lung injury induced by intestinal ischemia-reperfusion and explore it's possible underneath mechanism.
     Methods: 108 healthy rabbits were randomly divided into 6 groups (n=18 per group): normothermia intestinal ischemia-reperfusion groups (rectal temperature 37-38℃); mild hypothermia group (rectal temperature 32-35℃); moderate hypothermia group (rectal temperature 28-31.9℃); delayed mild hypothermia group (rectal temperature 32-35℃); delayed moderate hypothermia (rectal temperature 28-31.9℃); normothermia control group (rectal temperature 37-38℃, the sham group).The rabbit models of acute lung injury were produced by clamping super mesenteric artery (SMA) for 1 hour and declamping SMA for 6 hours. Hypothermia was induced by surface cooling. Monitoring heart rate, arterial pressure and breath rate and obtaining arterial blood for blood gas analysis. Before intestinal ischemia-reperfusion and 2, 4, 6 hours after, levels of TNF-α, IL-1β, IL-6, IL-10 in plasma were measured; six hours after intestinal ischemia-reperfusion, levels of PT, SP-A in plasma and TNF-α, IL-1β, IL-6, IL-10, SP-A in BALF were measured. Six hours after intestinal ischemia-reperfusion, eight rabbits selected randomly per group were killed to measure levels of MPO, MDA, SOD, the ATP enzyme, lung water and lactic acid in tissues of lung. Light microscopic examination was performed for morphological measurement of lung. The survival numbers of rabbits in 24 hours were observed.
     RESULTS: In IR groups, levels of TNF-α, IL-1β, IL-6, IL-10 in plasma and BALF increased, PaO_2 decreased, levels of SP-A increased in plasma and decreased in BALF. Lung water and the level of MPO, MDA and lactic acid increased in IR groups, SOD and the ATP enzyme in tissues of lung decreased. There were evidences of acute lung injury in morphological measurement of lung. The acute lung injury induced by intestinal ischemia-reperfusion were improved by hypothermia. Mild hypothermia was similar with moderate hypothermia in treatment of ALI induced by IIR. Mild hypithermia less impact than moderate hypothermia on hemodynamics, respiratory and blood coagulation. Delayed hypothermia improved partialy the acute lung injury induced by intestinal ischemia-reperfusion.
     Conclusion: (1) We observed rabbits ALI induced by IIR in this study. (2) Mild hypothermia and moderate hypothermia can improved significantly ALI induced by IIR in rabbits. (3) Mild hypothermia was similar with moderate hypothermia in treatment of ALI induced by IIR. Mild hypithermia less impacted than moderate hypothermia on hemodynamics, respiratory and blood coagulation. Mild hypothermia group's survival duration was longer than moderate hypothermia group. (4) Delayed hypothermia improved partialy the acute lung injury by intestinal ischemia-reperfusion.
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