Martling C R, Lundberg J M
Department of Anesthesia, Karolinska Institutet, Stockholm, Sweden.
Anesthesiology. 1988 Mar;68(3):350-6. doi: 10.1097/00000542-198803000-00005.
The formation of acute edema in the tracheobronchial mucosa following local instillation of hydrochloric acid or gastric juice was studied in rats. Protein extravasation using the Evans blue technique was measured and used to indicate edema formation. A pH dependent Evans blue extravasation was observed whereby pH 2 produced a small, pH 1.5 an intermediate, and pH 1 a pronounced effect. Also, gastric juice (pH 1.3 +/- 0.1) induced a marked Evans blue extravasation in the tracheobronchial mucosa. Rats which had been pretreated with capsaicin (100 mg/kg s.c.) had a much lower Evans blue extravasation following local instillation of both hydrochloric acid and gastric juice. Thus, the increase in Evans blue content induced by acid at pH 1.5 was abolished while about 50% of the response remained at pH 1. The protein extravasation caused by gastric juice was reduced by about 70% after capsaicin treatment. Terbutaline (73 nmol/kg, iv) or enprophylline (25 mumol/kg, iv) injected intravenously 10 min before, as well as hydrocortisone injected immediately after the intratracheal instillation of gastric juice, did not influence the magnitude of edema formation. Beta-methasone (0.25 mg/kg ip) pretreatment 24 h prior to the gastric juice exposure enhanced tracheal extravasation. In conclusion, acute protein extravasation in the lower airway mucosa induced by hydrochloric acid or gastric juice is mainly dependent on capsaicin sensitive sensory nerves, suggesting that local release of mediators, such as tachykinins, play a key role in this reaction.
在大鼠中研究了局部滴注盐酸或胃液后气管支气管黏膜急性水肿的形成。采用伊文思蓝技术测量蛋白质外渗，并以此指示水肿形成。观察到伊文思蓝外渗呈pH依赖性，即pH 2时产生轻微影响，pH 1.5时产生中等影响，pH 1时产生显著影响。此外，胃液（pH 1.3±0.1）可诱导气管支气管黏膜明显的伊文思蓝外渗。用辣椒素（100mg/kg皮下注射）预处理的大鼠，在局部滴注盐酸和胃液后，伊文思蓝外渗明显降低。因此，pH 1.5的酸诱导的伊文思蓝含量增加被消除，而在pH 1时约50%的反应仍然存在。辣椒素处理后，胃液引起的蛋白质外渗减少了约70%。在气管内滴注胃液前10分钟静脉注射特布他林（73nmol/kg）或恩丙茶碱（25μmol/kg），以及在滴注胃液后立即注射氢化可的松，均不影响水肿形成的程度。在暴露于胃液前24小时腹腔注射倍他米松（0.25mg/kg）预处理可增强气管外渗。总之，盐酸或胃液诱导的下呼吸道黏膜急性蛋白质外渗主要依赖于辣椒素敏感的感觉神经，提示速激肽等介质的局部释放在此反应中起关键作用。
