通气侧肺吸入伊洛前列素对肺动脉压和缺氧性肺血管收缩的影响

摘要

Objective To investigate the effect of aerosol inhalation of iloprost on pulmonary arterial pressure and hypoxic pulmonary vasoconstriction (HPV)during one-lung ventilation (OLV) in rats.Methods Thirty male rats were randomly divided into three groups,10 in each group. Models of lung perfusion were established,100% FiO 2 was ensured under the condition of OLV and the atomizers were opened.Atomization inhalation with normal saline was performed in group A,ilo-prost at a concentration of 0.05 μg·kg-1 ·min-1 in group B and iloprost at a concentration of 0.1μg·kg-1 ·min-1 in group C.Mean pulmonary artery pressure (MPAP)and PaO 2 of drainage-fluid from left atrium were recorded at time points of perfusion for 10 min (T1 ),aerosol inhalation for 10 min (T2 )and OLV for 1 h (T3 ).Oxygenation index (OI)was calculated with PaO 2 at each time point.Both lungs were harvested for electronic microscope detection.Results MPAPs at T2 and T3 were higher in contrast with that at T1 (P <0.05).A decrease of MPAP at T2 and T3 showed in group B and C when compared with those in group A (P <0.05).Group C had lower MPAP in comparison with group B at each time point.Considering the time span,we found that OIs at T2 and T3 were lower than that at T1 .In addition,OIs at T2 and T3 in group C were higher than those in group B,respectively.Under elec-tronic microscope,nuclear membranes typeⅡ alveolar epithelial cells of both lungs in group A and of non-ventilated lungs in group B and C bulged out or invaginated and lamellar bodies were evacuated,especially when compared to those in ventilated lungs in groups B and C.Conclusion In rat models of lung perfusion, atomization inhalation with iloprost can decreased MPAP,reduce intrapulmonary shunt and increase oxygen-ation.%目的：探讨雾化吸入伊洛前列素对大鼠单肺通气(one-lung ventilation,OLV)期间肺动脉压和缺氧性肺血管收缩(hypoxic pulmonary vasoconstriction,HPV)的影响。方法雄性 SD 大鼠30只,随机分为 A、B、C 三组,每组10只。原位离体肺灌注模型建立后,调整气管导管深度致左侧肺 OLV,FiO 2为100%,打开连接于呼吸回路的雾化器,A 组吸入生理盐水,B 组吸入伊洛前列素0.05μg·kg-1·min-1,C 组吸入伊洛前列素0.1μg·kg-1·min-1,记录灌注10 min(T1)、雾化吸入10 min(T2)和 OLV 1 h(T3)的平均肺动脉压(MPAP)及左心房引流液氧分压(PaO 2)。通过测量T1、T2和 T3时的左心房引流液 PaO 2计算氧合指数(oxygenation index,OI)。实验结束分别取双侧肺组织进行电镜检查。结果与 T1时比较,T2、T3时三组 MPAP 明显升高(P <0.05)；T2、T3时 B、C组 MPAP 明显低于 A 组(P <0.05),且 C 组 MPAP 明显低于 B 组(P <0.05)。与 T1时比较,T2、T3时三组 OI 明显降低(P <0.05)；T2、T3时 C 组 OI 明显高于 B 组(P <0.05)。相对于 B、C 组通气侧, A 组通气侧与 A、B、C 组非通气侧Ⅱ型肺泡上皮细胞核膜外突内陷,部分板层小体排空。结论在大鼠原位肺灌注模型中,单肺通气期间雾化吸入伊洛前列素能明显降低平均肺动脉压,减少肺内分流并增加氧合。