Song Zhi-fang, Xie Wei, Shan Hui-min, Guo Xiao-hong, Sun Bo
Intensive Care Unit,Xinhua Hospital of Shanghai Second Medical University, Shanghai 200092, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2006 Dec;18(12):716-20.
To evaluate the effect of glucocorticoid (GC) in the treatment of septic acute respiratory distress syndrome (ARDS).
ARDS model was reproduced by intraperitoneal injection of E.coli in piglets. Nine male piglets were randomly divided into control (C group), early (GC1) and middle (GC2) stage treatment groups. In the latter two groups methylprednisolone 20 mg was intravenously,given every 12 hours (4 mg(-1)xkg(-1)xd(-1)). All of the clinical data and survival time during 72 hours were collected and analyzed, including the collection of bronchioalveolar lavage fluid (BALF) for the determination of total protein (TP), total phospholipids (TPL), disaturated phosphatidyl choline (DSPC), and measurement of alveolar tension. Ratio of pulmonary wet and dry(W/D) weight was determined routinely, and pathological changes and their severity were evaluated by optical microscope and Smith scores.
ARDS model was reproduced at (8.3+/-8.5) hours, and survival time of three groups was (11.0+/-6.6) hours, (35.3+/-12.5) hours and (52.5+/-13.8) hours respectively. Animals in GC1 and GC2 survived longer than those in C group, but there was no statistically significant difference among them (both P>0.05).Oxygen index (PaO(2)/FiO(2)) and mean arterial pressure (MAP) were improved in GC1 much better than those of controls (both P<0.05), and the same was true in GC2 as compared that before GC treatment (P<0.05 or P<0.01). There were no significant differences among TPL, DSPC, white blood cell count (WBC) of BALF in each group, so were lung surface tension and W/D (all P>0.05). TP of BALF was significantly higher in GC1 than that in GC2. Compared with C group, alveolar and interstitial edema, inflammation and hemorrhage were more severe in GC1 (all P<0.01), hyaline membrane was less(P<0.01) and no difference in atelectasis (P>0.05). The alveolar and interstitial edema and inflammation in GC2 were more severe than in C group(all P<0.01), and there was no difference in hemorrhage and hyaline membrane formation (both P>0.05).
GC might improve hypoxemia and septic shock as a result of septic ARDS. But the treatment has no influence on pulmonary surfactant (PS), surface tension and lung pathology of ARDS in piglets challenged with intraperitoneal E.coli.
评估糖皮质激素（GC）治疗脓毒症急性呼吸窘迫综合征（ARDS）的效果。
通过腹腔注射大肠杆菌在仔猪中复制ARDS模型。9只雄性仔猪随机分为对照组（C组）、早期（GC1）和中期（GC2）治疗组。后两组每12小时静脉注射甲泼尼龙20mg（4mg·kg⁻¹·d⁻¹）。收集并分析所有临床数据及72小时内的生存时间，包括采集支气管肺泡灌洗液（BALF）以测定总蛋白（TP）、总磷脂（TPL）、二饱和磷脂酰胆碱（DSPC），并测量肺泡张力。常规测定肺湿重与干重之比（W/D），通过光学显微镜和史密斯评分评估病理变化及其严重程度。
ARDS模型在（8.3±8.5）小时复制成功，三组的生存时间分别为（11.0±6.6）小时、（35.3±12.5）小时和（52.5±13.8）小时。GC1组和GC2组动物的存活时间长于C组，但两组间差异无统计学意义（均P>0.05）。GC1组的氧合指数（PaO₂/FiO₂）和平均动脉压（MAP）改善程度明显优于对照组（均P<0.05），GC2组与GC治疗前相比情况相同（P<0.05或P<0.01）。各组BALF的TPL、DSPC、白细胞计数（WBC）以及肺表面张力和W/D差异均无统计学意义（均P>0.05）。GC1组BALF的TP显著高于GC2组。与C组相比，GC1组肺泡和间质水肿、炎症及出血更严重（均P<0.01），透明膜较少（P<0.01），肺不张无差异（P>0.05）。GC2组肺泡和间质水肿及炎症比C组更严重（均P<0.01），出血和透明膜形成无差异（均P>0.05）。
GC可能改善脓毒症ARDS所致的低氧血症和脓毒性休克。但该治疗对腹腔注射大肠杆菌攻击的仔猪ARDS的肺表面活性物质（PS）、表面张力及肺病理无影响。
