摘要：目的:探讨高容量机械通气对大白兔肺组织TNF-α、IL-1β、TGF-β1的作用.方法:将30只3月龄雄性大白兔随机分成3组:对照组、常规潮气量组及大潮气量组,每组各10只.对照组插管后不机械通气,另2组插管后机械通气.常规潮气量组VT8 mL/kg,大潮气量组VT 25 mL/kg,其它参数相同,通气时间24 h.观察实验前后动脉血pH值、PaO2及PaCO2的变化、ELISA法测定肺组织TNF-α、IL-1β,SABC法测定TGF-β1、测定肺组织湿/干重(W/D)值、观察肺组织病理学变化.结果:与对照组比较,大潮气量组通气24 h后动脉血pH、PaO2和PaCO2变化显著(均P＜0.05),肺组织W/D、TNF-α、IL-1β、TGF-β1升高(均P＜0.01),肺组织水肿,常规潮气量组相应指标无显著变化(P＞0.05).结论:大潮气量机械通气易发生呼吸机相关性肺损伤(VILI),表现为动脉氧分压、肺组织W/D、肺组织病理变化,同时肺组织TNF-α、IL-1β、TGF-β1升高,表明VILI与TNF-α、IL-1β、TGF-β1炎性细胞因子有关.%Objective: To explore the effect of high tidal mechanical ventilation on the expression of tumor necrosis factor-a (TNF-α) , interleukin-1β ( IL-1β ) and transforming growth factor-β1, (TGF-β1, ) in lung tissue of rabbits. Methods; Thirty healthy 3 month old male rabbits were randomly divided into control group, conventional tidal volume group and high tidal volume group ( 10 rabbits in each group). Rabbits in control group were not given mechanical ventilation after intubation, while the other 2 groups were given mechanical ventilation after intubation. Conventional tidal volume group (C-VT) ;VT; 8mL/kg, high tidal volume group (H-VT) : VT: 25mL/kg, both for 24 hours, and with same other parameters. Changes of arterial blood pH, PaO2 and PaCO2 were observed before and after experiment. Levels of TNF-a and IL-1β in the lung tissue were detected by ELISA, and TGF-β, was detected by SABC. The wet and dry weight ( W/D) ratio of lung tissue were calculated, and pathological changes of the lung tissue were observed. Results : Compared with those of control groups, arterial blood pH, PaO2 and PaCO2 changed significantly in high tidal volume group (P＜0. 05) , the lung tissue levels of W/D, TNF-α, IL-1β and TGF-β1 increased also in high tidal volume group (P ＜ 0. 01). There was no significant changes in lung tissue edema and corresponding indicators in conventional tidal volume group ( P ＞ 0. 05). Conclusions; High tidal volume ventilator are prone to develop ventilator induced lung injury (VILI) , manifested as the change of arterial oxygen pressure, lung tissue W/D, pathological changes of lung tissue, at the same time, TNF-α、NIL-β1 and TGF-β1 were increased. TNF-α、 IL-β1 and TGF-β, may play an important role in the occurrence and development of VILI.
