国际麻醉学与复苏杂志   2010, Issue (3): 211-214
    
丙泊酚对大鼠机械通气相关肺损伤的保护作用及机制
岳子勇 张莉莉 闫丹丹 王颖 崔晓光1()
1.150086,黑龙江省麻醉与危重病学研究重点实验室,哈尔滨医科大学附属第二医院麻醉科(岳子勇、张莉莉、闫丹丹、王颖、崔晓光)
The protection effects of propofol on ventilator-induced lung injury in rats
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摘要:

目的 探讨丙泊酚对大鼠机械通气相关肺损伤影响的作用机制。 方法 24 只 Wistar清洁级大鼠随机分为 3 组(n=8) , 采用压力控制机械通气模式通气 4h。A组为模型组, 通气模式为吸气峰压 (PIP) =25 cm H2O (1 cm H2O =0.098kPa) , 呼气末正压(PEEP) =2cm H2O ; B、 C组为同时输注丙泊酚组,通气模式同 A 组, B 组输注模式为静注 2 mg/kg,继以 4 mg·kg-1·h-1速度持续输注; C 组输注模式为 5 mg/kg,继以 10 mg·kg-1·h-1速度持续输注,记录基础时点、 1、 2、 3、4h 的 MAP、 HR 和动脉血气。 4h 后处死全部大鼠, 测量肺组织湿/干比 (W/D) , 支气管肺泡灌洗液 (bronchoalveolar lavage fluid,BALF) 中总蛋白、 肿瘤坏死因子α (tumor necrosis factora,TNF-α) 、 白介素1β (interleukin 1 β,IL-1β) 、 白介素6 (interleukin6,IL-6) 、 白介素10 (interleukin10,IL-10) 和巨噬细胞炎性蛋白 2 (macrophage inflammatory protein 2,MIP-2) 的含量, 肺组织匀浆中丙二醛 (malondialdehyde,MDA)和超氧化物歧化酶 (superoxide dismutase, SOD) 的含量, 观察肺组织病理形态学变化。 结果 A 组MAP 和PaO2在4h 时显著降低,由 (116.0±7.4)mm Hg(1 mm Hg=0.133 kPa) 和 (379±65)mm Hg降低到 (73±21)mm Hg和 (103±48)mm Hg, 与基础值相比差异有统计学意义 (P<0.05) , 而B、 C组与基础值相比差异无统计学意义。在 4h 时A组的 PaCO2显著升高 (P<0.05) , 而B、 C两组与基础值相比差异无统计学意义。肺组织湿/干比、 BALF 中总蛋白含量、 TNF-α 和 MIP-2浓度A组明显高于 B、 C组 (P<0.05) ,肺组织匀浆中MDA 浓度 A 组明显高于 B、 C 组 (P<0.05) , A组SOD 浓度也有所降低, 但和 B、 C 组差异无统计学意义。 肺组织学病理评分 B、 C 组也好于 A 组 (P<0.05) , B、 C 组间差异无统计学意义。 结论 丙泊酚可减轻大鼠机械通气相关肺损伤,其机制可能与其减少炎症因子的释放, 减少中性粒细胞在肺内的积聚, 抑制过氧化损伤有关。

关键词: 丙泊酚;机械通气相关肺损伤
Abstract:

Objective To investigate the mechanisms of propofol on ventilator-induced lung injury in rats produced by high PIP ventilation. Methods Twenty-four anesthetized Wistar rats weighting 280 g -320 g were randomly divided into three groups (n = 8). Rats were ventilated with high PIP pattern (PIP=25 cm H2O,PEEP=2 cm H2O) for 4 h. Propofol was given in a bolus of 2 mg/kg (group B) or 5 mg/kg (group C), followed by continuous infusion with 4 mg•kg-1•h-1 (group B)or 10 mg•kg-1•h-1(group C). No Propofol was given for group A. MAP, HR were recorded and arterial blood gases were analyzed. Lung wet and dry weight ratio(W/D), tumor necrosis factorα(TNF-α), interleukin1β(IL-1β), IL-6, IL-10, macrophage inflammatory protein2(MIP-2) and protein content in bronchoalveolar lavage fluid (BALF) , content of malondialdehyde(MDA) and superoxide dismutase (SOD) in lung homogenate were determined. Pathological change of lung was examined and lung injury was scored as well. Results MAP and PaO2 decreased from(116.0±7.4) mm Hg and (379±65) mm Hg to (73±21)mm Hg and (103±48)mm Hg, and PaCO2 increased at fourth hour in group A(P<0.05). PaO2 in group B and C were higher than in group A after 3 h(P<0.05). Lung W/D weight ratio, TNF-α, MIP-2 and protein content in BALF were higher in group A(P<0.05), and MDA was higher in group A(P<0.05). No significant difference between group B and C. Pathological changes of lung in group B and C were all better than those in group A. Conclusion Propofol may attenuate VILI in rats partly by reducing the release of cytokine, decreasing the accumulation of neutrophil in the lung, and inhibiting peroxidized injury.

Key words: Propofol; Ventilator-induced lung injury