论文部分内容阅读
目的:观察左西蒙旦联合精氨酸加压素对猪脓毒血症急性肺损伤的影响。方法:14只雌性猪麻醉后行气管插管及机械通气,建立腹腔感染模型,动物随机均分为去甲肾上腺素(NE)组和左西蒙旦+精氨酸加压素(LS+AVP)组。当平均动脉压(MAP)<60 mmHg时,NE组静脉泵注NE;LS+AVP组静脉泵注LS[0.4μg/(kg.min)]与AVP[0.57 mU/(kg.min)],必要时泵注NE以维持MAP在65～75 mmHg。记录模型建立前(基础值,T1)、休克时(T2,MAP<60 mmHg)、休克后6 h(T3)及12 h(T4)时MAP、平均肺动脉压(MPAP)、肺毛细血管楔压(PCWP)、动脉血氧饱和度(SaO2)、混合静脉血氧饱和度(SvO2)、乳酸(Lac)、血红蛋白浓度(Hb)、心输出量(CO),并计算动静脉分流率(Qs/Qt);记录两组动物休克发生时间、NE及液体需要总量;测定血浆中的TNF-α、IL-6、IL-10、NOax(一氧化氮代谢产物)及肺组织干湿比重(W/D)、髓过氧化物酶活性(MPO)、肺组织损伤程度及肺组织凋亡细胞数。结果:两组MAP、PCWP、休克发生时间、液体需要总量及Hb在各时间点比较差异无统计学意义(P>0.05)。与NE组比较,LS+AVP组T4时MPAP、Qs/Qt、Lac、IL-6及NOax显著降低,SvO2及SaO2显著升高(P<0.05);T3时HR、CO及TNF-α降低(P<0.05)。LS+AVP组NE需要总量、肺组织MPO活性、W/D及细胞凋亡数及肺组织评分显著低于NE组(P<0.05)。结论:与单独使用NE相比,LS联合AVP可改善脓毒血症猪急性肺损伤时的换气功能,降低MPAP并减轻肺部炎症反应。
Objective: To observe the effect of levosimendan combined with arginine vasopressin on acute lung injury induced by sepsis in swine. Methods: Fourteen female pigs were anesthetized and then were intubated and ventilated to establish the model of abdominal infection. The animals were randomly divided into norepinephrine (NE) group and levosimendan + arginine vasopressin (LS + AVP) group. NE was intravenously infused into NE group when the mean arterial pressure (MAP) was less than 60 mmHg; LS [0.4μg / (kg · min)] and AVP [0.57 mU / (kg · min) Pump NE as necessary to maintain MAP at 65-75 mmHg. MAP, mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (MAP) at 6 h (T3) and 12 h (T4) (PCWP), arterial oxygen saturation (SaO2), mixed venous oxygen saturation (SvO2), lactate (Lac), hemoglobin concentration (Hb) and cardiac output (CO) Qt). The time of onset of shock and the total amount of NE and fluid in the two groups were recorded. The levels of TNF-α, IL-6, IL-10, NOX and lung specific gravity / D), myeloperoxidase activity (MPO), lung injury and the number of apoptotic lung cells. Results: MAP, PCWP, time of onset of shock, total fluid requirement and Hb at different time points showed no significant difference (P> 0.05). Compared with the NE group, the levels of MPAP, Qs / Qt, Lac, IL-6 and NOax in LS + AVP group were significantly decreased and SvO2 and SaO2 significantly increased P <0.05). Neutrophil requirement, MPO activity, W / D and apoptosis in lung tissue and lung tissue score in LS + AVP group were significantly lower than those in NE group (P <0.05). CONCLUSIONS: LS combined with AVP improves ventilatory function in septic mice with acute lung injury, decreases MPAP, and attenuates lung inflammation compared with NE alone.