目的 探讨氦氧机械通气联合乌司他丁对盐酸诱导兔急性肺损伤(ALI)的影响.方法 将40只健康新西兰兔子随机分为生理盐水对照组(N组)、ALI模型组(M组)、氦氧机械通气治疗组(H组)、乌司他丁治疗组(U组)和氦氧机械通气联合乌司他丁治疗组(H+U组)各8只.5组均给予气管切开、机械通气,除了N组外,余各组均气管内滴注盐酸建立ALI模型.模型建立后,N、M组腹腔注射生理盐水,调整吸入氧浓度(FiO2)为50％;H组给予氦氧通气、腹腔注射生理盐水;U组腹腔注射乌司他丁,调整FiO2为50％;H+U组给予氦氧通气、腹腔注射乌司他丁.于气管插管后即刻、模型建立后即刻、治疗后4h记录各组兔子的气道峰压、胸肺总顺应性及PaO2.治疗4h后处死兔子,在光学显微镜下观察肺组织的病理学改变,检测肺组织髓过氧化物酶(MPO)含量及细胞凋亡指数(AI).结果 (1)5组间气道峰压比较,差异有统计学意义(P＜0.05),治疗4h后H组及H+U组的气道峰压较前明显降低,且均低于其余3组.(2)5组间胸肺总顺应性比较,差异有统计学意义(P＜0.05),治疗后4hH组及H+U组的胸肺总顺应性较前升高,且均高于其余3组.(3)5组间PaO2比较,差异有统计学意义(P＜0.05),治疗后4hM组、H组明显低于N组,但U组及U+H组接近N组水平.(4)治疗4h后,其余4组MPO水平均高于N组(P＜0.05),U组和H+U组的MPO活性较M组和H组明显降低(P＜0.05).(5)M组和H组的AI均高于N组(P＜0.05),M组和H组间比较,差异无统计学意义(P＞0.05);而U组和H+U组的AI均低于M组及H组(P＜0.05),U组和H+U组间比较,差异无统计学意义(P＞0.05).结论 氦氧机械通气联合乌司他丁能够通过降低气道峰压、改善氧合及胸肺总顺应性、抑制炎性细胞聚集及激活、减少肺组织细胞凋亡等途径对盐酸诱导的兔急性肺损伤有一定的保护作用.%Objective To investigate the effect of helium-oxygen mechanical ventilation combined with ulinastatin on rabbits with acute lung injury(ALI) induced by hydrochloric acid.Methods A total of 40 healthy New Zealand rabbits were randomly divided into saline control group (Group N),ALI model group (Group M),helium-oxygen mechanical ventilation group (Group H),ulinastatin group (Group U) and helium-oxygen mechanical ventilation combined with ulinastatin group(Group H + U),with 8 rabbits in each group.Tracheotomy and mechanical ventilation were conducted in 5 groups.ALI models were established by intra-tracheal instillation of hydrochloric acid solution in the other groups except Group N.After modeling,intraperitoneal injection with normal saline was conducted and fraction of inspired oxygen (FiO2) was adjusted to 50％ in Group N and Group M.Helium-oxygen mechanical ventilation and intraperitoneal injection with normal saline were conducted in Group H.Intraperitoneal injection with ulinastatin was conducted and FiO2 was adjusted to 50％ in Group U.Helium-oxygen mechanical ventilation and intraperitoneal injection with ulinastatin were conducted in Group H + U.The airway peak pressure,lung-thorax compliance and PaO2 of recorded at the instant of tracheal intubation completion,at the instant of model completion and after 4 hours of treatment in all groups.The rabbits were executed after 4 hour of treatment,then the pathological change of lung tissue was observed under light microscope,myeloperoxidase(MPO) content and apoptosis index(AI) of lung tissue were detected.Results ① There was significant difference in the airway peak pressure among 5 groups(P ＜ 0.05).After 4 hours of treatment,the airway peak pressures of Group H and Group H + U decreased significantly compared to those before treatment,and were lower than that of the other three groups.② There was significant difference in the lung-thorax compliance among 5 groups (P ＜ 0.05).After 4 hours of treatment,the lung-thorax compliance of Group H and Group H + U increased compared to those before treatment,and was higher than that of the other three groups.③ There was significant difference in PaO2 among 5 groups (P ＜ 0.05).After 4 hours of treatment,PaO2 of Group M and Group H was significantly lower than that of Group N,but PaO2 of Group U and Group U + H was close to the level of Group N.④ After 4 hours of treatment,the MPO activation of the other 4 groups was higher than that of Group N (P ＜ 0.05),the MPO activation of Group U and Group H + U was significantly lower than that of Group M and Group H(P ＜0.05).⑤ AI of Group M and Group H was higher than that of Group N(P ＜0.05),But there was no significant difference between Group M and Group H(P ＞0.05).AI of Group U and Group H +U was lower than that of Group N and Group H(P ＜0.05),and there was no significant difference between Group U and Group H + U (P ＞ 0.05).Conclusion Helium-oxygen mechanical ventilation combined with ulinastatin has protective effect on rabbits with ALI induced by hydrochloric acid through decreasing the airway peak pressure,improving oxygenation and lung-thorax compliance,inhibiting aggregation and activation of inflammation cells and reducing cell apoptosis of lung tissue.
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