中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

肺爆震伤早期集束化药物治疗方案的实验研究

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目的 观察联合山莨菪碱、地塞米松、氨溴索三种药物对早期(<48 h)一级肺爆震伤大鼠模型的动脉血气改善情况,血清炎性细胞因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)变化,以及肺部病理学表现的影响,探讨集束化治疗方案对早期肺爆震伤的临床意义。 方法 将 80 只 Wistar 大鼠随机分为 6 组:正常对照组(5 只),损伤组(15 只),氨溴索治疗组(15 只),地塞米松治疗组(15 只),山莨菪碱治疗组(15 只),以及联合氨溴索、地塞米松和山莨菪碱的集束化治疗组(15 只)。治疗组分别在成功建模后腹腔注射相应药物:氨溴索 46.7 mg/kg(每日 3 次)或/和地塞米松按 5 mg·kg–1·d–1或/和山莨菪碱按 3.33 mg/kg(每日 3 次);损伤组腹腔注射等体积生理盐水。观察致伤前和致伤后的呼吸频率、体重变化。各实验组分别在爆震伤后 6、24、48 h 各处死 5 只大鼠,收集动脉血气分析、Yelverton 病理评分、肺组织湿/干重比值、血清 TNF-α 和 IL-6 水平,并观察肺组织病理学表现。 结果 肺部爆震伤后,损伤组表现为渐进性呼吸性酸中毒,低氧血症,血清 IL-6、TNF-α 升高,呈时间相关性,氨溴索、地塞米松、山莨菪碱单独或联合应用组 PaO2 下降减轻,血清 IL-6、TNF-α 含量下降,肺组织病理水肿、炎症浸润减轻。 结论 大鼠肺爆震伤后,给予地塞米松、山莨菪碱、氨溴索药物干预后,其血气分析改善,炎症因子水平下降,肺损伤减轻,提示该三种药物对大鼠肺爆震伤有治疗作用,且存在相加作用,集束化治疗优于单药治疗。

Objective To observe the effects of cluster therapy combined with anisodamine, dexamethasone and ambroxol on arterial blood gas, inflammatory cytokines and pulmonary pathological changes by making an early (<48 h) primary blast lung injury model in rats. Methods Eighty Wistar rats were randomly divided into six groups, ie. a control group (n=5), an injury group (n=15), an ambroxol treatment group (n=15), a dexamethasone treatment group, a scopolamine treatment group (n=15), a combination of ambroxol, dexamethasone and anisodamine group (n=15). The treatment groups were injected intraperitoneally with ambroxol 46.7 mg/kg (three times a day) or (and) dexamethasone at 5 mg·kg–1·d–1 or (and) anisodamine at a dose of 3.33 mg/kg (three times a day). The rats in the injury group were injected intraperitoneally with an equal volume of normal saline. Respiratory rate and weight change were observed before and after injury. Five rats were sacrificed at 6 hours, 24 hours and 48 hours after injury in each experimental group. Arterial blood gas analysis, Yelverton pathological score, lung tissue wet/dry weight ratio, serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured. The lung histopathology was observed. Results After lung blast injury, the rats in the injury group showed progressive respiratory acidosis, and hypoxemia increased with the increase of IL-6 and TNF-α in a time-dependent manner. The PaO2 decreased in the groups with ambroxol, dexamethasone and anisodamine alone or in combination with anisodamine, and the contents of serum IL-6 and TNF-α decreased. Pathological edema and inflammatory infiltration of lung tissue were alleviated significantly. Conclusions After treatment with dexamethasone, anisodamine and ambroxol after lung blast injury, blood gas analysis is improved, inflammatory factor level is decreased and lung injury is alleviated, indicating that the three drugs can treat lung detonation injury in rats. The cluster therapy is superior to the single drug therapy.

关键词: 爆震伤; 急性肺损伤; 氨溴索; 地塞米松; 山莨菪碱; 集束化治疗

Key words: Blast injury; Acute lung injury; Ambroxol; Dexamethasone; Anisodamine; Cluster therapeutic regimen

引用本文: 苏时祯, 赖国祥, 张雷, 潘建光. 肺爆震伤早期集束化药物治疗方案的实验研究. 中国呼吸与危重监护杂志, 2019, 18(1): 57-64. doi: 10.7507/1671-6205.201806050 复制

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