高容量连续性血液滤过对猪实验性胰腺炎相关性肺损伤的影响。

Effects of high-volume continuous hemofiltration on experimental pancreatitis associated lung injury in pigs.

作者信息

Yan X-W, Li W-Q, Wang H, Zhang Z-H, Li N, Li J-S

机构信息

Medical School of Nanjing University, Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Nanjing, Jiangsu Province, China.

出版信息

Int J Artif Organs. 2006 Mar;29(3):293-302. doi: 10.1177/039139880602900307.

DOI:10.1177/039139880602900307

PMID:16685673

Abstract

OBJECTIVE

To investigate the effect of high-volume continuous hemofiltration on experimental pancreatitis associated lung injury (PALI) in pigs.

METHODS

Animals had severe acute pancreatitis (SAP) induced by intraductal injection of sodium taurocholate and trypsin and were randomly assigned to three groups: 1) Controls, 2) Low-volume (LV) (20 ml/kg/h) continuous venovenous hemofiltration (CVVH) and 3) High-volume (HV) (100 ml/kg/h) CVVH at the onset of the induction of SAP. Systemic and pulmonary hemodynamic index were monitored intermittently. At the same time, arterial oxygen tension (PaO 2 ), cytokines and activated NF- ê B levels of peripheral blood mononuclear cell were measured. After the animals died, the degree of microscopic lung injury was judged and scored.

RESULTS

The median survival times of control, low-volume and high-volume groups were respectively 41 h, 50 h and 65 h. Temperatures in high-volume CVVH group were more steady than in control and LV CVVH groups (p<0.01). MPAP was significantly decreased by 4-5 mmHg in the HV CVVH group after 12 h of treatment. PaO(2) was significantly higher in HV group than in LV group at 6 h , 12 h, 24 h and 48 h (p<0.01). HV CVVH resulted in significant reductions not only in interstitial edema and atelectasis but also hemorrhages, hyaline membranes, microthrombi and total lung injury histology score. Plasma cytokines in the high-volume group were significantly lower than in the LV and control groups. In the HV group, the expression of NF- ê B activation at 6 h, 12 h and 24 h was lower than in the control and LV groups respectively.

CONCLUSION

CVVH can reduce pulmonary edema and the severity of PALI in pigs with high-volume CVVH being significantly better than low-volume CVVH. The beneficial effects of CVVH on arterial oxygenation and pulmonary function may be connected with improvements in systemic hemodynamics, reduction in plasma cytokine concentration and decreased activity of NF- ê B in peripheral blood mononuclear cells.

摘要

目的

探讨高容量连续性血液滤过对猪实验性胰腺炎相关性肺损伤（PALI）的影响。

方法

通过胰胆管内注射牛磺胆酸钠和胰蛋白酶诱导动物发生重症急性胰腺炎（SAP），并将其随机分为三组：1）对照组；2）低容量（LV）（20 ml/kg/h）连续性静脉-静脉血液滤过（CVVH）组；3）在诱导SAP开始时进行高容量（HV）（100 ml/kg/h）CVVH组。间歇性监测全身和肺血流动力学指标。同时，测定动脉血氧分压（PaO₂）、细胞因子以及外周血单个核细胞中活化核因子κB水平。动物死亡后，判断并评估肺组织微观损伤程度。

结果

对照组、低容量组和高容量组的中位生存时间分别为41小时、50小时和65小时。高容量CVVH组的体温比对照组和低容量CVVH组更稳定（p<0.01）。治疗12小时后，高容量CVVH组的平均肺动脉压（MPAP）显著降低4 - 5 mmHg。在6小时、12小时、24小时和48小时时，高容量组的PaO₂显著高于低容量组（p<0.01）。高容量CVVH不仅使间质水肿和肺不张明显减轻，还使出血、透明膜、微血栓形成及全肺损伤组织学评分显著降低。高容量组血浆细胞因子水平显著低于低容量组和对照组。在高容量组中，6小时、12小时和24小时时核因子κB活化表达分别低于对照组和低容量组。