硫化氢吸入中毒肺毒理学及救治方案研究

应用支气管肺泡灌洗术、超速离心、光镜和电镜技术对大鼠硫化氢吸入中毒肺毒理学进行了研究。以支气管肺泡灌洗液(BALF)中的酶活性改变(LDH、AKP、ACP、ACE)作为细胞损伤的指标;BALF中白细胞数的变化作为炎症反应的指标;蛋白浓度和伊文思蓝浓度的改变作为通透性变化的指标。此外,还对硫化氢所致的脂质过氧化及天然抗氧化系统的作用,能量物质的受损以及BALF中磷脂含量的变化进行了研究,结合光镜和电镜观察,所得结果表明:(1)硫化氢对肺有强烈的细胞毒作用,因而导致肺各型细胞和肺组织严重损伤,并出现明显的肺水肿;(2)硫化氢所致的肺水肿是多种因素综合作用造成的;(3)生化改变较之病理变化出现早,恢复快。 对硫化氢吸入中毒的防治药物进行了筛选,证明高铁血红蛋白形成剂对小鼠、家兔、犬均有显著效果,但不能预防或减轻肺损伤;伍用激素、自由基清除剂、血管活性物质对减轻和促进肺损伤的恢复有良好作用。 根据实验研究结果,提出了硫化氢吸入中毒的救治方案。

Pulmonary Toxicology of H2S inhalation and its postulated therapy

The pulmonary toxicology after H2S inhalation was studied with bronchoaleveolar lavage (BAL),ultracentrifuge.and optical and electron microscopy in rats.The changes of the activities of lactate dehydrogenase,alkaline phosphatase,acid phosphatase and angiotension converting enzyme in BAL fluid were used as indicators of cellular damages.those of leucocytic count as the indicator of inflammatory response,and those of the concentration of protein and Evans blue as the indicator of the alterations of vascular permeability.In addition,the effects of H2S on lipid peroxidation,natural antioxidative system and energy substances and the changes of phospholipid concentration in BAL fluid were also studied.The results were as follows:(1)Inhalation of H2S exerted a severe cytotoxic effect on the lung tissues resulting in damages on various types of cells and a severe edematogenic effect on lung parenchyma.(2)The development of pulmonary edema in H2S intoxication resulted from a combination of different pathogenic factors.(3)The biochemical changes and their recovery occurred earlier than those of the pathological changes.The effecacy of 6 categories of drugs including 25 medicaments against H2S intoxication was e-valuated in mice,and 10 drugs were found prophylactically effective.The effects of various methe-moglobin-forming substances and some other drugs were also investingated in their treatment for H2S intoxication in rabbitsand dogs.It was concluded that methemoglobin-forming substances could be used as specific antidotes but could not prevent or diminish the lung damages due to H2S inhalation unless they were administered in association with dexamethasone,vitamin E,and anisodamine.Eventually,a postulated scheme of the medical treatment for H2S intoxication was presented.