Cheng Yumei, Yang Zhou, Shen Feng, Liu Bo, Wang Yahui, Wu Yanqi, Yao Ling, Liu Yuqing
Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China (Cheng YM, Shen F, Liu B, Wang YH, Wu YQ); Department of Anesthesiology, Center Hospital of Xiangyang, Xiangyang 441021, Hubei, China (Yang Z); Department of Intensive Care Unit, Second Affiliated Hospital of Guizhou Medical University, Kaili 556000, Guizhou, China (Yao L); Department of Intensive Care Unit, Zhenjiang Fourth People's Hospital, Zhenjiang 212000, Jiangsu, China (Liu YQ). Corresponding author: Shen Feng, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 May;30(5):434-438. doi: 10.3760/cma.j.issn.2095-4352.2018.05.008.
To compare the lung protection roles of intraperitoneal pre-injection with penehyclidine for two kinds of rat models with pulmonary and extrapulmonary acute respiratory distress syndrome (ARDSp and ARDSexp).
Forty healthy adult Sprague-Dawley (SD) rats were randomly divided into five groups (each n = 8): the rats in sham group received only tracheotomy; the ARDS rat models were reproduced by intratracheal inhalation of 0.1 mol/L hydrochloric acid (HCl) 2 mL/kg to simulate ARDSexp (HCl group) and 0.15 mL/kg oleic acid (OA) intravenous injection to simulate ARDSp (OA group) after tracheotomy; and the rats in two intervention groups were intraperitoneal injected with penehyclidine 0.5 mg/kg. All rats were received mechanical ventilation immediately after model reproduction. Carotid arterial blood was collected 4 hours after model reproduction for determining the arterial partial pressure of oxygen (PaO), and oxygenation index (PaO/FiO) was calculated. Carotid venous blood and lung tissues were harvested, and the levels of myeloperoxidase (MPO), interleukin-8 (IL-8) and nuclear factor-κB (NF-κB) in serum and lung tissue were determined by enzyme linked immunosorbent assay (ELISA). Pulmonary pathology was observed under optical microscope, and pathological score of Smith was calculated.
Under optical microscope, a large number of inflammatory cells infiltration in lung tissue, obvious alveolar collapse, fibrous exudation in alveolar and alveolar hyaline were found in HCl group. In OA group, however, microvascular congestion and interstitial pulmonary edema were the main pathological changes, with alveolar structure being kept relatively intact. Compared with sham group, pathological score of Smith in HCl and OA groups were increased, oxygenation was lowered, and inflammatory factors levels in serum and lung tissue were increased with levels in lung tissue being higher than those in serum, without significant difference between the two models. When pretreated with penehyclidine, however, pathological injury induced by HCl or OA was alleviated, and pathological score of Smith was also decreased as compared with that of corresponding model groups (5.48±1.76 vs. 9.69±2.02, 3.97±2.14 vs. 8.71±2.18, both P < 0.05), PaO/FiO was raised significantly [mmHg (1 mmHg = 0.133 kPa): 323±55 vs. 211±27, 307±56 vs. 207±31, both P < 0.05], the inflammatory factors levels in serum and lung tissue were obviously decreased [MPO (μg/L): 11.91±1.55 vs. 14.82±1.25, 12.75±1.16 vs. 16.97±2.06 in serum, 25.80±3.36 vs. 35.18±4.01, 24.23±1.24 vs. 33.94±1.43 in lung tissue; IL-8 (ng/L): 358±30 vs. 459±25, 377±38 vs. 427±34 in serum, 736±53 vs. 866±51, 701±53 vs. 809±39 in lung tissue; NF-κB (ng/L): 483±68 vs. 632±73, 514±83 vs. 685±78 in serum, 984±75 vs. 1 217±123, 944±90 vs. 1 163±105 in lung tissue; all P < 0.05]. But all parameters above were similar between the two pretreatment groups (all P > 0.05).
Inflammatory cell infiltration and alveolar collapse mainly happened in HCl induced ARDSp, while pulmonary interstitial edema and hemorrhage was mostly seen in ARDSexp rats induced by OA intravenous injection. There was no significant difference in oxygenation and inflammatory response between the two models of rats. Pre-intraperitoneal injection of penehyclidine equally improved oxygenation state, inhibited lung inflammation response, and reduced lung injury in the two kinds of ARDS, but there was no difference in protective role between two models pretreated with penehyclidine.
比较腹腔预注射戊乙奎醚对两种大鼠肺外源性和肺内源性急性呼吸窘迫综合征(ARDSp和ARDSexp)模型的肺保护作用。
将40只健康成年Sprague-Dawley(SD)大鼠随机分为五组(每组n = 8):假手术组大鼠仅行气管切开术;气管切开术后,通过气管内吸入2 mL/kg 0.1 mol/L盐酸(HCl)模拟ARDSexp(HCl组),静脉注射0.15 mL/kg油酸(OA)模拟ARDSp(OA组)来复制ARDS大鼠模型;两个干预组大鼠腹腔注射0.5 mg/kg戊乙奎醚。模型复制后所有大鼠立即接受机械通气。模型复制4小时后采集颈动脉血测定动脉血氧分压(PaO),并计算氧合指数(PaO/FiO)。采集颈静脉血和肺组织,采用酶联免疫吸附测定(ELISA)法测定血清和肺组织中髓过氧化物酶(MPO)、白细胞介素-8(IL-8)和核因子-κB(NF-κB)的水平。在光学显微镜下观察肺病理变化,并计算史密斯病理评分。
光学显微镜下,HCl组肺组织有大量炎性细胞浸润,肺泡明显塌陷,肺泡内有纤维渗出和肺泡透明膜形成。而OA组主要病理改变为微血管充血和间质性肺水肿,肺泡结构相对完整。与假手术组相比,HCl组和OA组史密斯病理评分升高,氧合降低,血清和肺组织中炎性因子水平升高,肺组织中水平高于血清,两种模型间无显著差异。然而,用戊乙奎醚预处理后,HCl或OA所致的病理损伤减轻,与相应模型组相比史密斯病理评分也降低(5.48±1.76 vs. 9.69±2.02,3.97±2.14 vs. 8.71±2.18,均P < 0.05),PaO/FiO显著升高[mmHg(1 mmHg = 0.133 kPa):323±55 vs. 211±27,307±56 vs. 207±31,均P < 0.05],血清和肺组织中炎性因子水平明显降低[血清中MPO(μg/L):11.91±1.55 vs. 14.82±1.25,12.75±1.16 vs. 16.97±2.06;肺组织中25.80±3.36 vs. 35.18±4.01,24.23±1.24 vs. 33.94±1.43;IL-8(ng/L):血清中358±30 vs. 459±25,377±38 vs. 427±34;肺组织中736±53 vs. 866±51,701±53 vs. 809±39;NF-κB(ng/L):血清中483±68 vs. 632±73,514±83 vs. 685±78;肺组织中984±75 vs. 1 217±123,944±90 vs. 1 163±105;均P < 0.05]。但上述所有参数在两个预处理组之间相似(均P > 0.05)。
HCl诱导的ARDSp主要表现为炎性细胞浸润和肺泡塌陷,而静脉注射OA诱导的ARDSexp大鼠主要表现为肺间质水肿和出血。两种大鼠模型在氧合和炎症反应方面无显著差异。腹腔预注射戊乙奎醚同样改善了两种ARDS的氧合状态,抑制了肺炎症反应,减轻了肺损伤,但戊乙奎醚预处理的两种模型在保护作用上无差异。