氨溴索预先给药对兔单肺通气时肺损伤的影响

目的 评价氨溴索预先给药对兔单肺通气时肺损伤的影响.方法 家兔67只随机分为4组,麻醉下气管插管,机械通气,A组(n=18)持续双肺通气4 h,B组(n=16)、C组(n=15)和D组(n=18)单肺通气2 h后恢复双肺通气2 h,C组和D组在单肺通气前分别静脉注射氨溴索5、15 mg/kg(生理盐水稀释至20 ml),B组给予等容量生理盐水.分别于麻醉前(基础状态)、单肺通气1、2 h、恢复双肺通气1、2 h时采集静脉血样,测定血清超氧化物歧化酶(SOD)活性、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和IL-8浓度,进行白细胞(WBC)计数和中性粒细胞计数,最后一次采集血样后,处死动物,取双侧肺组织,光镜下观察肺组织病理学.结果 与A组比较,B组、C组和D组SOD活性降低,TNF-α、IL-6、IL-8、WBC计数和中性粒细胞计数升高(P<0.05或0.01).与B组比较,C组和D组SOD活性升高,TNF-α、IL-6、IL-8、WBC计数和中性粒细胞计数降低(P<0.05或0.01).C组和D组间上述指标差异无统计学意义(P>0.05).A组双侧肺组织未见明显损伤;C组和D组非通气侧肺组织损伤轻于B组.结论 静脉注射氨溴索5、15 mg/kg可减轻单肺通气诱发兔肺损伤,其机制与抑制炎性反应及脂质过氧化反应有关.

Effects of ambroxol pretreatment on the lung injury during one-lung ventilation in rabbits

Objective To investigate the effects of ambroxol pretreatment on the lung injury during one-lung ventilation (OLV) in rabbits. Methods Sixty-seven rabbits of both sexes weighing 2.0-2.5 kg were randomly divided into 4 groups: group A two-lung ventilation (TLV) (n=18);group B OLV(n=16) ; group C ambroxol 5 mg/kg + OLV( n = 15) and group D ambroxol 15 mg/kg + OLV (n=18). The animals were anesthetized with intransuscular ketamine 25 mg/kg, tracheostomized and mechanically ventilated (FiO2 1.0, I:E 1:2, during TLV VT 10 ml/kg, RR 35 bpm, during OLV VT 7 ml/kg,RR 55 bpm). Bilateral lungs were ventilated for 4 h in group A. In group B, C and D unilateral lung was ventilated for 2 h followed by 2 h TLV. In group C and D ambroxol 5 and 15 mg/kg in normal saline (NS) 20 ml were given Ⅳ before OLV respectively while in group B equal volume of NS was given instead of ambroxol. Venous blood samples were taken before mechanical ventilation was started at 1 and 2 h of OLV and 1 and 2 h of TLV respectively for determination of serum SOD activity and serum TNF-α,IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte count. The lungs were then removed for microscopic examination. Results The serum SOD activity was significantly lower and TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulecyte counts were significantly higher in group B, C and D than in group A. Serum SOD activity was significantly higher and serum TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts were significantly lower in group C and D than in group B. There was no significant difference in the serum SOD activity, TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts between group C and D. The damage to the non-ventilated lung tissue was significantly ameliorated in group C and D as compared with group B. Conclusion Ambroxol 5 and 15 mg/kg iv can attenuate the lung injury during OLV by inhibiting inflammatory response and lipid peroxidation.