人参皂甙和酮布芬对烟雾吸入性肺损伤的影响

家兔烟雾吸入伤后6h,肺血管通透性和循环中血小板聚集率均明显增加,气管和肺部也有明显病变。治疗组于伤后15min静注人参总皂甙或酮布芬后6h,虽然两种药物均使循环中血小板聚集率显著降低,但只有人参总皂甙能明显降低伤后增加的肺血管通透性和减轻气管和肺部的病变。大白鼠在类似的实验条件下,人参总皂甙给药后1h,可使血中PGI_2水平升高,TXA_2/PGI_2的比值明显下降。     

The Effects of Ginsenosides on Smoke Inhalation Injury in Rats

A rat model was used to explore the therapeutic effects of ginsenosides (GS)on smoke inhalation long injury.It was found that GS could markedly alleviate the in-crease of pulmonary microvascular permeability (PMVP),reduction of protein and leu-cocyte content in the bronchoalveolar lavage fluid (BALF) of the smoke inhalation injur-ed rats.Histopathological studies of the lungs revealed that GS could distinctly reduceleucocyte accumulation in the vessels,interstitial infiltration of leucocytes,interstitial andintra-alveolar edema,hemorrhage and vascular congestion.Meanwhile,GS could inhibitthe elevation of malondialdehyde (MDA) in the lungs and serum and reverse the decrea-sed activity of superoxide dismutase (SOD) in the lungs after smoke inhalation.In addi-tion experiments in vitro also showed the inhibition of lipid peroxidation in lung homo-genate and elimination of superoxide anions hydroxyl radicals effectively by GS in properdoses.These results imply that there is close interrelationship between the therapeuticefficiency of GS on smoke inhalation lung injury and its capability of antioxidation.     

Studies of the MDL 74405 effects on plasma and tissue MDA level after inhalation injury in rats

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MDL74405对实验性烟雾吸入伤大鼠血浆及组织MDA水平的影响

本研究采用大鼠烟雾吸入伤模型，观察了抗氧化剂维生素Ｅ（Ｖｉｔ Ｅ）同系物ＭＤＬ ７４４０５（０．２，１，５ｍｇ／ｋｇ，气管内给药）对吸入性损伤的疗效。结果发现，ＭＤＬ ７４４０５能明显降低血浆，肺、肝、心和小肠组织脂质过氧化物丙二醛（ＭＤＡ）水平，减轻气管及肺组织损伤，使氧分压（ＰａＯ２）升高，二氧化碳分压（ＰａＣＯ２）下降，改善呼吸功能，且疗效比Ｖｉｔ Ｅ好，可能与ＭＤＬ ７４４０５的强大清除自     

Effects of tetrandrine on the changes of free calcium level in neutrophils after smoke inhalation injury in the rabbit

The changes of the cytoplasmic free calcium level in the neutrophils after smoke in-halation injury were observed in rabbits and then the effects of tetrandrine,a calcium antago-nist,on the changes of free calcium level were studied.It was found that the number of neu-trophils increased significantly preceded by a transient decrease in the blood and also increasedin the bronehoalveolar lavage fluid after smoke inhalation.and the level of cytoplasmic free calci-um in the blood neutrophil increased likewise.Administration of tetrandrine resulted in a reduc-tion of the neutrophils number in the lungs and the free calcium level in the blood neutrophils toalleviate the pulmonary injury due to smoke inhalation.It is believed that there is a close rela-tionship between the activation of neutrophils and the pathophysiological changes of the lungs,and tetrandrine can exert its therapeutic effects on the injury by decreasing the free calcium levelin the neutrophils to modulate their functions.     

粉防己碱对吸入伤家兔肺表面活性物质活性的影响及意义

本文探讨了肺泡表面活性物质变化与兔吸入伤肺水肿的关系;同时,还探讨了钙拮抗剂粉防己碱(Tet)对肺的保护作用与减少肺表面活性物质破坏的关系。结果发现:致伤后肺泡表面活性物质下降同时,PaO_2下降,PaCO_2升高,肺血管外水量也显著增加。病理检查示肺部炎症水肿性改变。Tet治疗组,肺表面活性物质破坏减少,血气改善,肺部炎症及水肿减轻。提示Tet减轻肺损伤的作用,至少部分是通过减少肺表面活性物质破坏。并提出Tet可能是通过抑制磷脂酶A_2活性,减少肺表面活性物质分解而发挥作用的假设。     

家兔烟雾吸入后血小板聚集和血清纤维蛋白降解产物的动态变化

本实验采用比浊法(Born's法)和葡萄球菌猬集试验分别检测了家兔烟雾吸入伤后,外周血中血小板最大聚集率(PAR)和血清纤维蛋白降解产物(FDP)的变化,并辅以肺水量和肺脏的病理检查。结果表明:PAR于伤后2、10小时明显升高;血小板计数从伤后30分钟开始明显减少,持续24小时;伤后血中FDP升高,以6、24小时最为明显。病理检查发现:伤后动物有肺泡内水肿及出血,肺间质有纤维蛋白沉积,肺小血管内血小板凝集、脱颗粒;肺水量明显增加。伤后血小板和FDP的变化与动物的呼吸困难加重相一致。因而认为:烟雾吸入伤后,血小板和FDP在肺损伤的发展中可能起一定重要作用。     

早期大容量肺灌洗对犬重度单肺吸入伤引起的对侧肺损害的影响

目的：研究大容量灌洗对犬一侧肺急性重度烟雾吸入伤引起的对侧肺损害的影响,求证早期肺灌洗减轻吸入伤犬肺继发性炎症反应的有效性。方法：建立犬左肺单侧急性重度烟雾吸入伤模型,伤后1h对伤肺进行生理盐水大容量灌洗。观察自主呼吸24h间灌洗组犬与未灌洗组犬双肺换气功能,比较24h后两组犬两侧肺标本之病理学和病理生理学变化程度。结果：左肺灌注总量250ml,简单负压吸引后单肺灌注液存留量90-140ml。伤后立即灌洗组与未灌洗组犬PaO2均显著下降,灌洗组犬灌洗后PaO2立即进一步下降,2h后逐渐回升,伤后24h时已反超未灌洗组犬;两组犬左肺均呈现重度肺水肿及肺出血,右肺呈轻-中度肺水肿,灌洗组犬右肺肺水含量小于未灌洗组犬,右肺动、静态顺应性大于未灌洗组犬。结论：早期大容量灌洗可减轻犬一侧肺急性重度烟雾吸入伤时对侧肺损害程度,即有效减少了吸入伤犬肺后续炎症反应。     

粒细胞在犬烟雾吸入性肺损伤中的作用

利用重度犬烟雾吸入伤模型,观察了血中粒细胞的动态变化,及其在烟雾吸入性肺损伤中的作用。伤后血中粒细胞很快向肺内聚集和浸润;多核粒细胞(PMN)对自体细胞的毒性效应显著增强;PMN释放的髓过氧化物酶不断增加;代表氧自由基产生的PMN化学发光显著改变;这些变化均先于肺损伤,与其损伤时相基本一致。提示肺内粒细胞聚集和浸润在吸入性肺损伤中具有重要作用,颗粒酶和氧自由基可能是粒细胞介导肺损伤的效应因素。     

Effects of early bronchoalveolar lavage fluid collected from dogs with smokeinhalation injury on the lungs of rats

Whether early massive bronchoalveolar lavage can remove the harmful substances from the lungs injured with smoke inhalation remains uncertain. This study was designed to observe the effects of early massive bronchoalveolar lavage fluid (BALF) on the healthy lungs in rats. Methods: Mongrel dogs were inflicted with severe smoke inhalation injury.. The injured lungs were lavaged with large amount of normal saline in the first hour after injury and the BALF was collected. The BALF was injected into the healthy lungs of 30 rats (group C) in the dosage of 5 ml/kg. The functions and pathological changes of the lungs were observed 24 h after perfusion with the BALF. The data were compared with those of 23 rats (group B) whose lungs were perfused with the BALF collected from normal dogs and those of 21 rats (group A) whose lungs were perfused with normal saline. Results: The mortality rate 24 h after lung perfusion was higher in group C than in groups A and B. The survivors of group C exhibited fluctuation of respiratory rate (RR), remarkable decrease of PaO2, significantly higher content of lung water, decrease of total static pnlmonary, compliance and pulmonary expansion index, and increasse of inflammatory cytokines in the tissues of lungs. Only slight mechanic obstructive effect on the airway was observed in rats of group A and B. The pathological changes of the lungs of the rats in group C were similar to those of the dogs with actual smoke inhalation injury.. Conclusion: Our findings indicate that the BALF collected from dogs with acute severe smoke inhalation injury, in the early stage after injury injured the normal lungs of rats with the bioactive substances in the BALF. These findings show us that it is a valuable therapeutic procedure to apply massive bronchoalveolar fluid lavage in the early stage after inhalation injury.     

Changes of Thromboxane and Prostacyclin after Smoke Inhalation Injury in Goats

Thirteen goats with chronic lung lymph fistula were inflicted withsmoke inhalation injury.Thromboxane A_2(TXA_2 in terms of thromboxane B_2 orTXB_2)and prostacyclin(PGl_2 in terms of 6-keto-prostaglandin F_(1x)or6-keto-PGF_1x)in plasma,lung lymph and lung tissue were measured withradioimmunoassay(RIA).Extravascular lung water(EVLW),lung lymph flow(QL),the ratio of protein contents between lung lymph and plasma(LIP),hemodynamic parameters,blood gases,platelet and leukocyte counts were alsodetermined.EVLW,QL and L/P increased significantly at the 1st hour,reachedtheir peak values at the 2nd hour,then declined gradually and remained at a levelover the baseline at the 6th hour after injury.TXA_2 and PGl_2 also increasedmarkedly and the.changes of TXA_2 and TXA_2/PGI_2 ratio were in parallel withthose of EVLW,QL and LIP both in degree and in length of time.It is possiblethat the increased TXA_2 and TXA_2/PGI_2 ratio might participate in the formationof permeability pulmonary edema through direct injury and for chemical mediatorsreleased by platelet and leukocyte aggregations promoted by TXA_2.In addition,TXA_2 might also play a role in the early elevation of pulmonary arterial pressure.     

烟雾吸入伤家兔血中性粒细胞游离钙的变化及粉防己碱的作用

本文探讨了血中性粒细胞(PMN)游离钙水平〔Ca~(2+〕_i的变化与烟雾吸入性损伤的关系,同时还观察了钙拮抗剂粉防己碱对游离钙水平的影响与减轻吸入伤作用的关系。发现致伤后,血PMN数目有一短暂下降后持续升高,支气管肺泡灌洗液中PMN数目却明显增加;血PMN〔Ca~(2+)〕_i水平也明显增加。粉防己碱可以减少肺内PMN数目,降低血PMN〔Ca~(2+)〕_i水平,并且减轻吸入性损伤。提示PMN的活化与吸入伤的病理生理改变密切相关,粉防己碱可能是通过降低PMN〔Ca~(2+)〕_i水平,调节PMN功能,发挥其治疗作用。     

人参总皂甙对大鼠烟雾吸入性肺损伤的疗效与其抗氧化作用的关系

本实验采用大鼠烟雾吸入性肺损伤模型,观察了致伤后立即腹腔注射人参总皂甙(GS)对该损伤的作用。发现GS可明显减轻烟雾吸入所致PMVP增加,减少BALF中WBC计数和蛋白含量,使肺内WBC浸润,肺水肿,肺充血、出血等病变减轻。GS还可抑制致伤大鼠肺和血清MDA的升高,使已降低了的肺SOD活性恢复至正常水平以上。体外实验也发现,GS可有效地抑制肺匀浆过氧化脂质生成和清除O_2~-·、OH·。提示GS的治疗效果与其抗氧化作用有关。     

Dynamic Changes of Platelet Aggregation and Serum Fibrin Degradation Products after Smoke Inhalation Injury in Rabbits

This study was designed to observe the dynamic changes of plateletaggregation with Born's method and serum fibrin degradation products(FDP)with staphy lococcus clumping test after smoke inhalation in rabbits.Pathological studies of the lung tissues and determination of the lung water werealso carried out after the animals were killed.It was found that there was marked increase of the platelet aggregation ratein the 2nd and 10th hour postburn(PB),and the platelet count decreasedprogressively after injury.FDP increased in the 6th and 24th hour PB.Pathologically,there were congestion,interstitial edema and alveolar hemorrhageand edema in the lungs.Under electron microscope,it was found that plateletaggregation occurred in the lumen of small pulmonary vessels.Most plateletswere deformed with evacuation of their granules.In addition,the lung watercontent increased apparently.In association with these changes,the animalsexhibited difficulty in breathing and rales over the chest.On the basis of our obervation,it is thus proposed that the changes ofplatelets and FDP may play important roles in the development of pulmonaryedema after smoke inhalation.     

氧合氟碳液早期肺灌洗对犬重度单肺吸入伤的影响--与生理盐水肺灌洗的比较

目的 与生理盐水肺灌洗比较，研究评价氧合氟碳液PFC早期肺灌洗治疗犬重度单肺吸入伤的优缺点。方法 建立犬左肺单侧急性重度烟雾吸入伤模型，伤后1h对伤肺进行氧合氟碳液PFC或生理不大容量灌洗。观察自主呼吸24h内犬双肺换气功能，肺病理和病理生理学变化程度，计算两种灌洗液的清洁效率。结果 （1）生理盐水和PFC肺灌洗均可有效清除下呼吸道，减轻吸入伤引起的原发性和继发性肺组织结构改变；（2）生理盐水灌洗犬左肺伤后24h肺功能无改善而右肺和全肺功能相对未灌洗犬有一定改善；（3）PFC肺灌洗清洁功能不及生理盐水，但灌洗犬近期肺功能显著优于生理盐水灌洗犬和吸入伤后自然演变组犬。结论 早期大容量肺灌洗可有效减少吸入伤犬肺继发性炎症反应，氧合氟碳液灌洗在显示近期综合疗效方面有优越性。     

高频振荡通气对烟雾吸入性肺损伤致急性呼吸窘迫综合征患者的临床疗效

目的 探讨烟雾吸入性肺损伤导致急性呼吸窘迫综合征 (ARDS) 患者治疗中高频振荡通气方式的临床价值.方法 选取2010至2015年入院治疗的烟雾吸入性肺损伤引发ARDS患者50例, 随机平均分为2组, 分别选择常规机械通气与高频振荡通气治疗.结果 治疗后2组患者PaO2、PaCO2、PaO2/FiO2均改善 (P<0.05) , 研究组患者改善明显优于对照组 (P<0.05) ;研究组患者通气时间与住院时间相比对照组明显缩短 (P<0.05) ;2组患者30 d内死亡率以及并发症发生率差异无统计学意义 (P>0.05) .结论 高频振荡通气治疗能够有效改善烟雾吸入性肺损伤引发ARDS, 提高患者氧合指标, 在临床预后改善方面没有发现明显的优势.     

烟雾吸入性损伤修复模型IL-1β和PGE2的动态变化分析

目的：探讨IL-1β和PGE2在新西兰白兔烟雾吸入性损伤修复中动态水平变化．方法：新西兰白兔36只,随机分为正常对照组、烟雾吸入性损伤后第1,4,7,14,21日,共6组,应用ELISA方法检测各组IL-1β和PGE2的水平．建立烟雾吸入性损伤修复模型,光镜下观察烟雾吸入对新西兰白兔气管、肺组织的病理变化．结果：①病理变化表明烟雾吸入性损伤第1,4,7日组以损伤后炎症反应为主（损伤期）,第14,21日组以损伤后修复为主（修复期）;②ELISA结果表明：IL-1β含量在烟雾吸入性损伤后第1日[（196．2±67．8）ng／L]立即升高,与正常对照组[（7．1±0．2）ng／L]比较有统计学差异（P〈0．05）,至第7日[（398．5±161．4）ng／L]达到顶峰后逐渐下降,至第21日[（9．3±3．7）ng／L]最低,与正常对照组比较无统计学差异;PGE2含量在烟雾吸入性损伤后第1日[（4．4±1．0）μg/L]至14日[（120．9±61．1）μg／L]逐渐升高,在第14日达到顶峰后下降,第14日组与正常对照组[（4．4±1．0）μg/L]比较有显著差异（P〈0．05）,至第21日[（6．4±2．8）ng／L]最低,与正常对照组比较无统计学差异．结论：通过建立烟雾吸入性损伤修复模型,观察IL-1β与PGE2的动态水平变化,可为临床上判断烟雾吸入性损伤修复过程不同阶段（损伤期、修复期）提供帮助,也表明IL-1β与PGE2在烟雾吸入性损伤修复过程中可能具有重要作用．     

兔烟雾吸入性损伤模型的改进和建立

目的 改进并建立一种兔烟雾吸入性损伤模型 方法 参照以往兔烟雾吸入性损伤模型制作方法,采用自制烟雾吸入性损伤致伤仪致伤,改进模型制作方法：以干燥的松木屑及煤油为发烟材料,在密闭环境使兔自行吸入烟雾10min,间隔2min再次致伤10min。伤后观察兔临床表现、各时点血气及伤后24h肺组织切片观察。 结果 (1)伤后兔呼吸频率明显加快,呼吸困难明显,肺部可及干啰音,24h后呼吸症状改善。(2) 血气示PaO2由伤前90.20±18.44mmHg分别降至伤后10min 63.48±12.90mmHg、伤后2h 56.96±10.23mmHg及伤后4h 65.76±12.55mmHg,与伤前比较差异有显著性(P<0.05)。至伤后24h基本恢复正常;PaCO2由伤前32.10±5.48mmHg分别升至伤后10min 41.72±6.33mmHg、伤后2h 43.12±5.42mmHg及伤后4h 39.11±6.91mmHg与伤前比较差异有显著性(P<0.05)。至伤后24h基本恢复正常。(3)肺组织切片：伤肺有血管内充血、肺泡水肿和出血、间质水肿及炎性细胞浸润等肺损伤改变。致伤过程无动物死亡。结论 本文推荐的兔烟雾吸入性损伤模型是一种简便、实用、稳定、经济、可重复的烟雾吸入性损伤模型,适于烟雾吸入性损伤的研究。     

烟雾吸入性损伤修复中IL-1βmRNA和COX-2mRNA的表达变化及意义

目的:探讨IL-1β和COX-2在新西兰白兔烟雾吸入性损伤修复中表达的变化及其作用。方法:将新西兰白兔36只随机分为正常对照组、烟雾吸入性损伤后第1天,第4天,第7天,第14天,第21天,共6组,应用RT-PCR方法检测各组IL-1βmRNA和COX-2mRNA的表达。建立烟雾吸入性损伤修复模型,光镜下观察烟雾吸入对新西兰白兔气管、肺组织的病理变化。结果:(1)病理变化表明烟雾吸入性损伤第1、4、7天组以损伤后炎症反应为主(损伤期),第14、21天组以损伤后修复为主(修复期),这表明烟雾吸入性损伤修复模型成功建立;(2)RT-PCR结果表明:IL-1βmRNA表达在烟雾吸入性损伤后第1天立即升高,与正常对照组比较有极显著性差异(P<0.01),损伤期第1、4天组IL-1βmRNA表达明显高于修复期第14、21天组,第4天组(1.75±0.31)与第14天组(0.75±0.33)比较有极显著性差异(P<0.01);COX-2mRNA表达在烟雾吸入性损伤后第1天升高,与正常对照组比较有显著性差异(P<0.05),在第21天达到最高,修复期第14、21天组COX-2mRNA表达明显高于损伤期第1、4天组,第14天组(1.86±0.31)与第1天组(1.03±0.26)比较有极显著性差异(P<0.01)。结论:通过建立烟雾吸入性损伤修复模型,检测IL-1βmRNA与COX-2mRNA表达变化,发现IL-1βmRNA在损伤期表达上调,而COX-2mRNA在修复期表达升高,表明IL-1β和COX-2在烟雾吸入性损伤修复过程中可能具有重要作用。     

Changes of length of elastic fibers in rabbit lungs after smoke inhalation injury.

Pulmonary morphometry was determined in rabbit lungs after smoke inhalation. Twenty-four hours after injury, changes of the total lung volume (TLV) and the total length of all parenchymal elastic fibers (LT) were measured. Concomitant changes in arterial blood gas levels and pathomorphology of lung tissues were also studied. It was found that alveolar walls were broken and became thinner, and that alveoli were dilated. TLV was markedly increased and LT was markedly decreased as compared to normal lungs (P less than 0.05). These findings suggest that proteinases, especially elastase, released from phagocytes may play an important role in acute lung injury after smoke inhalation.