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目的研究不同容量机械通气对急性呼吸窘迫综合征(ARDS)大鼠脑损伤的作用机制。方法将30只SD大鼠随机分为对照组、盐酸+高潮气量组(HCL+HV组)和盐酸+低潮气量组(HCL+LV组),每组10只。两个模型组麻醉后均从气管注入0.1 mol盐酸。HCL+LV组通气容量为6 ml/kg体重,通气末正压为3 cm H2O;HCL+HV组通气容量为15 ml/kg体重,通气末正压为0 cm H2O。各组大鼠连续通气6 h后处死,行肺泡灌洗并取肺及脑海马组织进行病理观察,并用ELISA法检测脑组织中的相关指标。对照组麻醉后无需特殊处理即行相关指标检测。结果模型组大鼠可见肺组织中ARDS病理改变,海马组织中间质血管轻度扩张充血。与对照组比较,HCL+HV组和HCL+LV组的脑组织中还原型谷胱甘肽(GSH)含量明显降低(P均<0.05),而巨噬细胞炎症蛋白-2(MIP-2)、S-100β及IL-6含量明显升高(P均<0.05)。与HCL+HV组相比,HCL+LV组脑组织中MIP-2、IL-6及S-100β含量明显降低(P均<0.05)。结论HCL诱导的ARDS大鼠在机械通气情况下有远隔部位脑损伤的表现,低容量机械通气对ARDS大鼠的脑损伤有协同保护作用。
Objective To investigate the mechanism of brain injury in rats with acute respiratory distress syndrome (ARDS) with different volume of mechanical ventilation. Methods Thirty SD rats were randomly divided into control group, hydrochloric acid + high tidal volume group (HCL + HV group) and hydrochloric acid + low tidal volume group (HCL + LV group), with 10 rats in each group. Both models were anesthetized from the trachea with 0.1 mol hydrochloric acid. The ventilation volume of HCL + LV group was 6 ml / kg body weight and the positive pressure of ventilation was 3 cm H2O. The ventilation volume of HCL + HV group was 15 ml / kg body weight and the positive pressure of ventilation was 0 cm H2O. The rats in each group were sacrificed 6 hours after continuous ventilation, then the lungs and hippocampus were harvested for pathological observation after alveolar lavage. The relevant indexes in brain tissues were detected by ELISA. Control group without anesthesia after the relevant indicators of the need for special treatment. Results The pathological changes of ARDS in the lung tissue were observed in the model group, and the dilation and hyperemia of the interstitial blood vessels in the hippocampus tissue were observed. Compared with the control group, the content of reduced glutathione (GSH) in the brain tissue of HCL + HV group and HCL + LV group was significantly decreased (P <0.05), whereas MIP-2 , S-100β and IL-6 levels were significantly increased (all P <0.05). The levels of MIP-2, IL-6 and S-100β in HCL + LV group were significantly lower than those in HCL + HV group (all P <0.05). Conclusion HCL-induced acute respiratory distress syndrome (ARDS) rats have distant parts of brain injury under mechanical ventilation. Low-volume mechanical ventilation has a synergistic protective effect on brain injury in ARDS rats.