本文選題：地塞米松 + 輔助比例通氣��； 參考：《安徽醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的觀察地塞米松治療幼兔胎糞吸入時(shí)臨床參數(shù)、TNF-α、IL-8、環(huán)氧化酶水平和肺組織病理的變化。 方法24只日齡20-30天的健康日本大耳幼兔隨機(jī)分為3組,具體分組如下： (1)空白組(n=8)：氣管插管后不灌胎糞; (2)生理鹽水組(n=8)：氣管插管后注入4ml/kg的45mg/ml胎糞混合物,在胎糞灌入后1h和3h靜脈注射生理鹽水0.5mg/kg； (3)地塞米松組(n=8)：氣管插管后注入4ml/kg的45mg/ml胎糞混合物,胎糞灌入后1h和3h靜脈注射地塞米松0.5mg/kg； 3組均在呼吸機(jī)比例輔助通氣模式下通氣,維持潮氣量6-8ml/kg、血氧飽和度85%以上和呼氣末二氧化碳分壓(35-45mmHg)為目標(biāo)調(diào)節(jié)呼吸機(jī)參數(shù),8h后處死。分別于灌前10分鐘(0點(diǎn))、灌后10分鐘(0’點(diǎn))以及通氣2h、4h、6h、8h記錄各組的循環(huán)及呼吸力學(xué)參數(shù),包括心率、呼吸頻率、順應(yīng)性。在時(shí)間點(diǎn)0’點(diǎn),2h和6h時(shí)檢測(cè)動(dòng)脈血?dú)?計(jì)算氧合指數(shù)(OI)和P02/Fi02比值(P/F值)值。通氣8小時(shí)后處死,左肺做濕干重比(W/D),右肺上葉蘇木素-伊紅(HE)染色,觀察肺組織病理改變并進(jìn)行肺損傷病理評(píng)分,右肺下葉做肺組織勻漿和支氣管肺泡灌洗液(BALF),并用酶聯(lián)免疫吸附試驗(yàn)測(cè)定TFN-α、1L-8、COX-1和COX-2的含量。 結(jié)果： 1.通氣8h各觀察指標(biāo)：生理鹽水組和地塞米松組,RR、HR比較差異無統(tǒng)計(jì)學(xué)意義,P0.05；VT比較差異有統(tǒng)計(jì)學(xué)意義,P0.05。 2.動(dòng)脈血?dú)饨Y(jié)果分析：通氣2h動(dòng)脈血血?dú)夥治鼋Y(jié)果：3組間P02、 PCO2、 PH比較差異均無統(tǒng)計(jì)學(xué)意義,P0.05；通氣6h動(dòng)脈血血?dú)夥治鼋Y(jié)果：3組間PO2、PCO2、 PH比較差異均無統(tǒng)計(jì)學(xué)意義,P0.05。 3.動(dòng)態(tài)順應(yīng)性：3組間比較,在0時(shí)間點(diǎn)差異無統(tǒng)計(jì)學(xué)意義(F=0.073,P=0.789),其余時(shí)間點(diǎn)差異均有統(tǒng)計(jì)學(xué)意義；其中生理鹽水組和地塞米松兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。 4.氧合指數(shù)(OI)值：重復(fù)測(cè)量比較：3組間整體比較,差異有統(tǒng)計(jì)學(xué)意義(F=253.314,P=0.000),地塞米松組顯著高于生理鹽水組；時(shí)間點(diǎn)與組間無交互作用(P=1.000)；2h和6h間整體比較,差異有統(tǒng)計(jì)學(xué)意義(F=27.317,P=0.000),6h時(shí)間點(diǎn)顯著高于2h時(shí)間點(diǎn)。 5.PO2/FiO2比值：重復(fù)測(cè)量的比較：3組間整體比較,差異有統(tǒng)計(jì)學(xué)意義(F=3097.358,P=0.000),地塞米松組顯著高于生理鹽水組；時(shí)間點(diǎn)與組間無交互作用(P=0.728)；2h和6h間整體比較,差異有統(tǒng)計(jì)學(xué)意義(F=16.420,P=0.000),6h較2h顯著降低。 6.肺組織濕干重比(W/D)：3組間比較,差異有統(tǒng)計(jì)學(xué)意義(F=48.014,P=0.000),各組間比較差異有顯著性意義(P=0.000),其中生理鹽水組最高,空白組最低。 7.肺損傷評(píng)分：3組間比較差異有統(tǒng)計(jì)學(xué)意義(F=361.061,P=0.000),各組間比較差異有顯著性意義(P=0.000),其中生理鹽水組最高,空白組最低,病理觀察生理鹽水組肺組織含炎性細(xì)胞較多且彌漫性水腫較重。 8.TNF-α、IL-8含量比較：BALF和肺組織勻漿中TNF-α、IL-8含量對(duì)照組均低于地塞米松組和生理鹽水組,地塞米松組低于生理鹽水組[BALF中TNF-a(pg/ml):(29.2±2.0)、(47.8±3.8)、(59.2±4.4),IL-8(pg/m1)：(297.4±10.9)、(444.3±48.6)、(596.1±90.8);肺組織勻漿中TNF-a：(40.2±2.3)、(57.4±6.2)、(76.2±7.7),IL-8：(187.9±11.0)、(485.3±30.2)、(645.0±13.7)],差異有統(tǒng)計(jì)學(xué)意義(P均0.05)。 9.環(huán)氧化酶含量比較：3組間肺泡灌洗液和肺組織勻漿中環(huán)氧化酶1含量比較,差異均無統(tǒng)計(jì)學(xué)意義(均P0.05)�？瞻捉M、生理鹽水組、地塞米松組3組間,肺泡灌洗液中環(huán)氧化酶2含量[(1.07±0.84)μg/L、(3.98±0.54)μ g/L、(2.58±0.43)μg/L]比較,差異均有統(tǒng)計(jì)學(xué)意義(均P0.05),肺組織勻漿中[(1.22±0.77)μg/L、(6.14±0.18)μg/L、(5.33±0.57)μ g/L]差異亦均有統(tǒng)計(jì)學(xué)意義(均P0.05)。 結(jié)論： 4.1.胎糞吸入后可引起炎癥因子的過度釋放,引起急性肺損傷改變： 4.2.地塞米松可能通過抑制炎癥因子TNF-α, IL-8,COX-2的釋放,減輕胎糞吸入導(dǎo)致的急性肺損傷； 4.3.地塞米松能改善幼兔重度胎糞吸入時(shí)的肺部氧合狀態(tài)； 4.4.地塞米松可減輕幼兔重度胎糞吸入造成的肺水腫及病理改變； 4.5.地塞米松對(duì)幼兔重度胎糞吸入時(shí)的心率和呼吸頻率變化小；
[Abstract]:Objective To observe the clinical parameters , TNF - 偽 , IL - 8 , cyclooxygenase ( COX ) levels and pathological changes in lung tissues of young rabbits treated with dexamethasone .

Methods 24 healthy Japanese young rabbits aged 20 - 30 days old were randomly divided into 3 groups , the specific groups were as follows :

( 1 ) blank group ( n = 8 ) : no manure was poured after tracheal intubation ;

( 2 ) Normal saline group ( n = 8 ) : After tracheal intubation , 4 ml / kg of 45 mg / ml fetal dung mixture was injected , and the normal saline was injected at 0.5 mg / kg for 1 h and 3 h after irrigation .


( 3 ) Dexamethasone group ( n = 8 ) : After tracheal intubation , 4 ml / kg of fetal dung mixture was injected into 4 ml / kg , and dexamethasone 0.5 mg / kg was injected intravenously at 1h and 3h .


The parameters of circulatory and respiratory mechanics , including heart rate , respiratory rate and compliance , were recorded at 0 ' , 2 h , and 6 h after aeration . The lung tissues were sacrificed after 8 hours of aeration , lung tissue homogenate and lung injury pathology were observed , and the contents of TFN - 偽 , 1L - 8 , COX - 1 and COX - 2 were measured by enzyme - linked immunosorbent assay .

Results :

1 . After 8 hours of ventilation , the indexes of observation : physiological saline group and dexamethasone group , RR and HR showed no statistical significance , P0.05 ;
There was significant difference in VT compared with that of VT ( P0.05 ) .

2 . Arterial blood gas analysis : The results of arterial blood gas analysis showed that there was no significant difference between group 3 and P02 , PCO2 and PH , P0.05 ;
Results : There was no significant difference in PO2 , PCO2 and PH between three groups ( P0.05 ) .

3 . Dynamic compliance : There was no significant difference between the three groups ( F = 0.073 , P = 0.789 ) .
There were significant differences between physiological saline group and dexamethasone ( P0.05 ) .

4 . Oxygenation index ( OI ) value : The comparison between the three groups was statistically significant ( F = 253.314 , P = 0.000 ) , and the dexamethasone group was significantly higher than that in physiological saline group .
There was no interaction between the time point and the group ( P = 0.000 ) ;
The difference was statistically significant between 2h and 6h ( F = 27.317 , P = 0.000 ) , and the time point of 6h was significantly higher than 2h time point .

5 . PO2 / FiO2 ratio : The comparison between the three groups was statistically significant ( F = 3097.358 , P = 0.000 ) , and the dexamethasone group was significantly higher than that in physiological saline group .
There was no interaction between the time point and the group ( P = 0.728 ) .
The difference was statistically significant between 2 h and 6 h ( F = 16.420 , P = 0.000 ) , which was significantly lower than 2h at 6h .

6 . The wet and dry weight ratio of lung tissues ( W / D ) : 3 groups were statistically significant ( F = 48.014 , P = 0.000 ) , and there was a significant difference among the groups ( P = 0.000 ) , among which the saline group was the highest and the blank group was the lowest .

7 . There was significant difference between the three groups ( F = 361.061 , P = 0.000 ) . There was a significant difference between the groups ( P = 0.000 ) .

The levels of TNF - 偽 and IL - 8 in BALF and lung tissue homogenate were lower than those in dexamethasone group and normal saline group . The levels of TNF - a : ( 44.2 鹵 2.3 ) , ( 59.4 鹵 6.9 ) , ( 74.3 鹵 48.6 ) , ( 56.1 鹵 90.8 ) , ( 74.2 鹵 7.7 ) , IL - 8 : ( 187.9 鹵 11.0 ) , ( 485.3 鹵 39.2 ) , ( 645.0 鹵 13.7 ) were significantly higher in the lung tissue homogenate ( P < 0.05 ) .

9 . The content of cyclooxygenase - 1 in alveolar lavage fluid and lung tissue homogenate was significantly higher than that in three groups ( P0.05 ) . The difference was statistically significant ( P < 0.05 ) , and the difference of the levels of the pulmonary tissue homogenate ( 1.22 鹵 0.77 ) 渭g / L , ( 6.14 鹵 0.18 ) 渭g / L , ( 5.33 鹵 0.57 ) 渭g / L was significant ( all P0.05 ) .

Conclusion :

4.1 . Excessive release of inflammatory factors after ingestion of fetal feces , resulting in changes in acute lung injury :

4.2 . Dexamethasone may alleviate acute lung injury caused by the release of inflammatory cytokines TNF - 偽 , IL - 8 , COX - 2 .


4 . 3 . Dexamethasone could improve the oxygenation of the lungs of young rabbits with severe fetal feces inhalation .


4.4 . Dexamethasone can reduce the pulmonary edema and pathological changes caused by heavy fetal feces inhalation in young rabbits .


4 . 5 . The rate of heart rate and respiratory rate was small in the case of severe fetal feces inhalation in young rabbits .

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R722.1

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