Chen C M, Fang C L, Chang C H
Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan.
Crit Care Med. 2001 Nov;29(11):2169-75. doi: 10.1097/00003246-200111000-00020.
To evaluate pulmonary responses to intratracheal administration of surfactant with and without dexamethasone in rats with paraquat-induced lung injury.
Prospective, randomized, controlled study.
University research facility.
Adult male Sprague Dawley rats.
Rats were anesthetized and underwent a tracheostomy and arterial catheter insertion 3 days after intraperitoneal injection of paraquat (35 mg/kg). The rats were ventilated for 90 mins after sequential designation as controls or as recipients of intratracheal surfactant alone (50 or 100 mg/kg) or surfactant (50 or 100 mg/kg) plus dexamethasone (0.5 mg/kg).
Arterial blood gases were determined at 15, 30, 60, and 90 mins. After 90 mins of ventilation, a static pressure-volume curve was performed, and inflammatory cells, total protein content, and cytokines were measured in bronchoalveolar lavage fluid. Postmortem histology was then examined. Treatment with 50 mg/kg dexamethasone/Survanta and 100 mg/kg Survanta with and without dexamethasone significantly increased oxygenation shortly after instillation when compared with the control group, with the response maintained throughout the study period. Static pressure-volume curves showed that the group receiving 100 mg/kg dexamethasone/Survanta had significantly higher lung volumes than the control group. Total cell, neutrophil, and macrophage counts were decreased significantly in the animals treated with 100 mg/kg dexamethasone/Survanta compared with untreated control rats. Total protein recovered from bronchoalveolar lavage fluid in the animals treated with 100 mg/kg Survanta with and without dexamethasone was decreased significantly compared with control animals. The histologic appearance of the lungs was markedly better in the groups treated with surfactant with or without dexamethasone.
Results suggest that the combined administration of high doses of intratracheal surfactant and dexamethasone improves gas exchange, ameliorates lung inflammation, and alleviates lung damage after paraquat-induced lung injury. Surfactant alone and lower doses of surfactant plus dexamethasone had a lesser effect on these measures.
评估在百草枯诱导的肺损伤大鼠中，气管内给予表面活性剂（有无地塞米松）后的肺部反应。
前瞻性、随机、对照研究。
大学研究机构。
成年雄性Sprague Dawley大鼠。
大鼠在腹腔注射百草枯（35 mg/kg）3天后麻醉，行气管切开术和动脉导管插入术。依次分为对照组、单纯气管内给予表面活性剂（50或100 mg/kg）组或表面活性剂（50或100 mg/kg）加地塞米松（0.5 mg/kg）组，通气90分钟。
在15、30、60和90分钟时测定动脉血气。通气90分钟后，绘制静态压力-容积曲线，并检测支气管肺泡灌洗液中的炎症细胞、总蛋白含量和细胞因子。然后进行尸检组织学检查。与对照组相比，给予50 mg/kg地塞米松/固尔苏以及100 mg/kg固尔苏（有无地塞米松）治疗后，给药后不久氧合显著增加，且在整个研究期间维持该反应。静态压力-容积曲线显示，接受100 mg/kg地塞米松/固尔苏的组肺容积显著高于对照组。与未治疗的对照大鼠相比，接受100 mg/kg地塞米松/固尔苏治疗组动物的总细胞、中性粒细胞和巨噬细胞计数显著降低。与对照动物相比，给予100 mg/kg固尔苏（有无地塞米松）治疗组动物支气管肺泡灌洗液中回收的总蛋白显著降低。给予表面活性剂（有无地塞米松）治疗组的肺组织学表现明显更好。
结果表明，高剂量气管内表面活性剂与地塞米松联合应用可改善气体交换，减轻肺部炎症，并减轻百草枯诱导的肺损伤后的肺损伤。单独使用表面活性剂以及低剂量表面活性剂加地塞米松对这些指标的影响较小。
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