本文選題：急性呼吸窘迫綜合征　切入點：心功能　出處：《遵義醫(yī)學院》2012年碩士論文　論文類型：學位論文

【摘要】：目的：觀察機械通氣聯(lián)合甲基戊乙奎醚(penehyelidine hydrochloride, PHCD)對急性呼吸窘迫綜合征(acute respiratory distress syndrome, ARDS)急性期大鼠心功能、心臟局部腎素-血管緊張素系統(tǒng)(renin-angiotensin system, RAS)的影響,初步探討PHCD對ARDS大鼠心功能的保護作用及其相關(guān)機制,為臨床治療提供有效的科學依據(jù)。 方法：健康雄性Sprague-Dawley大鼠90只,鼠齡12-16周,隨機分為五組,每組18只：假手術(shù)NS對照組(A組)：僅進行氣管切開插管和右頸總動脈穿刺置管,尾靜脈注射生理鹽水0.15ml/kg; ARDS未干預組(B組)：尾靜脈注射油酸0.15ml/kg,建立油酸誘導的大鼠ARDS模型；ARDS機械通氣治療組(C組)：潮氣量(tidal volume, VT)=6ml/kg,呼吸頻率(respiratory rate, RR)=60次/分,吸入氧濃度(fraction of inspiration O2, FiO2)=50%,吸呼比(I：E)=1：2,呼氣終末正壓(positive end-expiratory pressure, PEEP)=3cmH2O; ARDS PHCD治療組(D組)：腹腔內(nèi)注射PHCD0.017mg/kg; ARDS機械通氣+PHCD聯(lián)合治療組(E組)：呼吸機參數(shù)同C組,PHCD用法及用量同D組。各組按造模成功后時間又分為a、b、c3個亞組,每組有效檢測與活殺取材的大鼠均為6只。分別記錄大鼠ARDS后1小時.ARDS后2小時、ARDS后4小時心率(heart rate, HR)、右頸總動脈收縮壓(systolic blood pressure, SBP)、右頸總動脈舒張壓(diastolic blood pressure, DBP)、左心室最大收縮壓(left ventricular systolic pressure, LVSP)、左心室舒張末期壓力(left ventricular end-diastolic pressure, LVEDP)、左心室內(nèi)最大上升速率(maximum rising rate of left intraventricular pressure,+LVdp/dtmax)及左心室內(nèi)最大下降速率(maximum falling rate of left intraventricular pressure,-LVdp/dtmax);各組分別在對應時間點上取動脈血后處死大鼠。取左室心肌組織放射免疫法檢測血管緊張素I (angiotensin I, Ang I)、血管緊張素II (angiotensin II, Ang II)含量及腎素(Renin)活性；酶聯(lián)免疫吸附法(enzyme linked immunosorbent assay, ELISA)測定血清中大鼠心肌肌鈣蛋白T(cardiac troponin T, cTnT)及腦鈉素(brain natriuretic peptide, BNP)水平。運用PASW Statistics v18.0統(tǒng)計軟件單因素方差分析及Pearson相關(guān)分析分析結(jié)果。 結(jié)果：同時間點與A組相比,B、C、D、E組LVSP、±LVdp/dtmax明顯降低(P0.05),LVEDP明顯升高(P0.05),Ang Ⅰ、Ang Ⅱ含量及Renin活性均顯著增加(P0.05),血清cTnT和BNP水平明顯升高(P0.05)。同時間點與B組相比,C組LVSP、±Vdp/dtmax有所升高,LVEDP有所降低,Ang Ⅰ、Ang Ⅱ含量及Renin活性均有所降低,血清cTnT和BNP水平也有所降低,但所有指標均無統(tǒng)計學意義(P0.05),D組LVSP、±LVdp/dtmax明顯升高(P0.05),LVEDP明顯降低(P0.05),血清cTnT和BNP水平均明顯降低(P0.05),Ang Ⅰ、Ang Ⅱ含量及Renin活性均有降低,但無統(tǒng)計學意義(P0.05),E組LVSP、±LVdp/dtmax明顯升高(P0.05),LVEDP明顯降低(P0.05),血清cTnT和BNP水平、心肌組織Ang Ⅰ、Ang Ⅱ含量及Renin活性均明顯降低(P0.05)。大鼠心肌局部Ang Ⅱ含量及Renin活性與LVSP、±Vdp/dtmax呈負相關(guān),與LVEDP、血清cTnT及BNP含量呈正相關(guān)。 結(jié)論：ARDS可致大鼠心肌損害、心功能降低,并激活心臟局部的RAS；機械通氣聯(lián)合甲基戊乙奎醚可明顯改善ARDS大鼠的心功能,對心肌局部RAS激活水平存在間接抑制作用。
[Abstract]:Objective: To observe the effects of mechanical ventilation combined with penehyclidine hydrochloride (penehyelidine, hydrochloride, PHCD) on acute respiratory distress syndrome (acute respiratory distress syndrome, ARDS) of heart function in acute stage of rat cardiac renin-angiotensin system (renin-angiotensin system RAS) effect, preliminary study of protective effects of PHCD on heart function of ARDS rats and its related mechanism, and provides scientific basis for clinical treatment.
Methods: 90 healthy male Sprague-Dawley rats, rats aged 12-16 weeks, were randomly divided into five groups, 18 rats in each group: sham operation NS group (group A): only tracheotomy and the right carotid artery catheterization, intravenous injection of saline 0.15ml/kg; ARDS without intervention group (group B) intravenous injection of oleic acid 0.15ml/kg, a rat model of ARDS induced by oleic acid; ARDS mechanical ventilation group (C group): tidal volume (tidal volume, VT =6ml/kg), respiratory rate (respiratory rate, RR) =60 / min, inhaled oxygen concentration (fraction of inspiration O2, FiO2 =50%), respiratory ratio (I:E =1:2), positive end expiratory pressure (positive end-expiratory pressure, PEEP =3cmH2O; ARDS PHCD) treatment group (D group): intraperitoneal injection of PHCD0.017mg/kg; mechanical ventilation in ARDS +PHCD treatment group (E group): ventilator parameters with the C group, PHCD usage and dosage with D groups. According to the successful model After the time is divided into a, B, C3 groups, each group of effective detection and killed materials are 6 rats were recorded. 2 hours after ARDS in rats 1 hours after.ARDS, 4 hours after ARDS, heart rate (heart rate, HR), the right carotid artery systolic blood pressure (systolic, blood pressure, SBP), the right carotid artery diastolic pressure (diastolic, blood pressure, DBP), left ventricular systolic pressure (left ventricular systolic max pressure, LVSP), left ventricular end diastolic pressure (left ventricular end-diastolic pressure, LVEDP), the left ventricle maximum rise rate (maximum rising rate of left intraventricular pressure, and +LVdp/dtmax) the left ventricle maximum decline rate (maximum falling rate of left intraventricular pressure, -LVdp/dtmax); arterial blood at the corresponding time point respectively after the rats were sacrificed. The left ventricular muscle were detected by radioimmunoassay. Angiotensin I (Ang Iotensin I, Ang I), angiotensin II (angiotensin II, Ang II) and the content of renin (Renin) activity; enzyme linked immunosorbent assay (enzyme linked immunosorbent assay, ELISA) were measured in serum cardiac troponin T (cardiac troponin T, cTnT) and brain natriuretic peptide (brain natriuretic peptide, BNP the level of PASW Statistics V18.0). The use of statistical software single factor variance analysis and Pearson correlation analysis results.
緇撴灉錛氬悓鏃墮棿鐐逛笌A緇勭浉姣，

本文編號：1633493