摘要
目的：观察外源性肺表面活性物质（ＰＳ）早期治疗对脓毒性急性肺损伤（ＡＬＩ）的疗效及对内源性ＰＳ的影响。方法：实验动物在机械通气下建立脓毒性ＡＬＩ模型，早期气管内注入有机提取的ＰＳ１００ｍｇ／ｋｇ，连续治疗６小时。观察氧合指数（ＰａＯ２／ＦｉＯ２）、肺内分流（Ｑｓ／Ｑｔ）、肺动态顺应性（Ｃｄｙｎ）的变化；并对支气管肺泡灌洗液（ＢＡＬＦ）磷脂含量和表面张力进行分析。用Ｗｅｓｔｅｒｎｄｏｔｂｌｏｔ法测定ＰＳ特异性结合蛋白（ＳＰＡ）含量，用Ｎｏｒｔｈｅｒｎｂｌｏｔ法测定ＳＰＡｍＲＮＡ的变化。结果：实验动物的ＰａＯ２／ＦｉＯ２、Ｑｓ／Ｑｔ和Ｃｄｙｎ在治疗后早期无明显改善，后期有明显肺损伤时较未治疗组有显著改善，分别为（３４．９±２．６）ｋＰａ比（２９．９±３．４）ｋＰａ、（１９．３０×１０－２±１．２６×１０－２比２４．１０×１０－２±１．９７×１０－２）和（６．２２±０．３１）ｍｌ／ｋＰａ比（５．４１±０．４１）ｍｌ／ｋＰａ，Ｐ均＜０．０１。ＰＳ治疗后能显著升高总磷脂〔ＴＰＬ，（２７．１±２．９）ｍｇ／ｋｇ比（７．８±１．１）ｍｇ／ｋｇ〕、饱和磷脂／ＴＰＬ（ＤＳＰＣ／ＴＰＬ，０．４１±０．０４比０．２７±０．０６）?
Objective:To determine the therapeutic efficacy of exogenous pulmonary surfactant (PS) on septic acute lung injury (ALI),and its effect on alternations in endogenous surfactant system.Methods:We established an ALI exogenous PS in rabbits for 6 hours.Changes in PaO 2/FiO 2,[AKQ·5〗s/t,C dyn were observed,and total phosphorous (TPL),disaturated phodphatidlcholine (DSPC),large aggregate (LA) as well as the surfactant film tension of branchalvolar fluid (BALF) were measured in animals with or without PS treatment.In addition,surfactant associated protein SPA and SP A mRNA were determined by Western dot blot and Northern blot respectively.Results:Treatment with the PS in later phase of septic ALI significantly improved PaO 2/FiO 2,s/t and C dyn compared with nonPS treated group PaO 2/FiO 2:(34 9±2 6) kPa vs.(29 9± 3 4)kPa ;s/t:19 30×10 -2 ±1 26×10 -2 vs.24 10×10 -2 ±1 97×10 -2 ;C dyn :(6 22±0 31)ml/kPa vs.( 5 41±0 41 ) ml/kPa,all P <0 01 .Concomitantly,exogenous PS could markedly elevate TPL (27 1± 2 9)mg/kg vs.(7 8±1 1)mg/kg ,DSPC/TPL(0 41±0 04 vs.0 27±0 06) and TPL in LA (14 20± 1 05)mg/kg vs.(3 68±0 39)mg/kg ,but reduced the surfactant film tension (2 70±1 84)mN/m vs.(20 90± 0 67)mN/m .No significant differences in cell counts,total protein,and SPA protein were observed between animals with and without SP treatment.In addition,no inhibitory effect on SPA mRNA expression was found by exogenous PS (50 3±8 9 vs.49 7±7 1, P >0 05).Conclusions:The exogenous PS appears to be effective in later phase rather than early phase of septic ALI,it can improve the endogenous surfactant activity,without obvious influence on pulmonary inflammatory response.Also,the therapeutic efficacy of exogenous PS would be enhanced if administration method,preparation type and composition are improved.
出处
《中国危重病急救医学》
CAS
CSCD
1999年第2期92-95,共4页
Chinese Critical Care Medicine
基金
华瑞基金
上海医科大学博士研究生课题
