Smith Adam, Brown Roger, Jugg Bronwen, Platt Janet, Mann Thomas, Masey Charles, Jenner John, Rice Paul
Biomedical Sciences Department, Defence Science and Technology Laboratory, UK.
Mil Med. 2009 Dec;174(12):1287-94. doi: 10.7205/milmed-d-09-00050.
Toxic industrial chemicals e.g., phosgene, are widely used as reactive intermediates in industrial processes. Inhalation exposure to these chemicals can result in life-threatening acute lung injury (ALI), to which no specific antidote exists. This study aimed to assess the potential benefit of steroids in treating phosgene induced ALI. Anesthetized pigs were instrumented, exposed to phosgene Ct 2000 mg.min.m(-3) (Ct is the product of concentration [mg.m(-3)] x time [min]), and ventilated with intermittent positive pressure ventilation before being randomized to study part 1: treatment with intravenous glucose saline (20 mL) or methylprednisolone (12.5 mg.kg(-1) in 20 mL) 6 h postexposure or study part 2: treatment with inhaled glucose saline (2 mL) or budesonide (2 mL of 0.5 mg.mL(-1) solution) at 1, 6, 12, and 18 h postexposure. Biochemical parameters and animal physiology were monitored to 24 h postexposure. The results show no change in mortality, lung edema, or shunt fraction; however, some beneficial effects on cardiac parameters e.g., stroke volume, left ventricular stroke work, were noted. Steroids were neither beneficial nor detrimental in the treatment of phosgene induced ALI. This study does not support the use of steroids alone as a treatment, but their use in a combined therapy strategy should be investigated.
有毒工业化学品，如光气，在工业生产过程中被广泛用作反应中间体。吸入接触这些化学品可导致危及生命的急性肺损伤（ALI），对此尚无特效解毒剂。本研究旨在评估类固醇在治疗光气诱导的ALI中的潜在益处。对麻醉猪进行仪器安装，使其暴露于光气中，浓度时间乘积（Ct）为2000 mg·min·m⁻³（Ct是浓度[mg·m⁻³]×时间[min]的乘积），并在间歇性正压通气下进行通气，然后随机分为研究部分1：暴露后6小时静脉注射葡萄糖盐水（20 mL）或甲泼尼龙（12.5 mg·kg⁻¹溶于20 mL），或研究部分2：暴露后1、6、12和18小时吸入葡萄糖盐水（2 mL）或布地奈德（2 mL的0.5 mg·mL⁻¹溶液）。监测暴露后24小时的生化参数和动物生理指标。结果显示死亡率、肺水肿或分流分数无变化；然而，观察到对心脏参数有一些有益影响，如每搏输出量、左心室搏功。类固醇在治疗光气诱导的ALI中既无益处也无害处。本研究不支持单独使用类固醇进行治疗，但应研究其在联合治疗策略中的应用。
