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目的探讨不同潮气量致新生大鼠呼吸机相关性肺损伤(VILI)的临床特点。方法新生大鼠32只。随机分为对照组(无通气)、常规通气组(潮气量0.010 L.kg-1,通气5 h)、过度通气5 h组(潮气量0.025 L.kg-1,通气5 h)和过度通气3 h组(潮气量0.025 L.kg-1,通气3 h)。机械通气后测定其肺质量,计算肺系数,观察其病理变化,进行肺损伤评分,ELISA法检测其肺组织IL-6、IL-10水平。结果过度通气5 h组、过度通气3 h组、常规通气组和对照组肺损伤病理评分分别为(9.63±1.40)分、(4.40±1.06)分、(6.50±1.85)分和0.00分,4组间比较差异有统计学意义(P=0.000)。过度通气5 h组、过度通气3 h组、常规通气组和对照组肺组织IL-6水平分别为(785.33±39.06)pg.g-1、(656.78±48.82)pg.g-1、(701.6±33.65)pg.g-1和(635.02±65.78)pg.g-1,4组间比较差异有统计学意义(P=0.000)。肺组织IL-6水平与肺损伤评分呈正相关(r=0.78,P<0.01)。各组间IL-10水平比较差异无统计学意义(P=0.940)。过度通气5 h组IL-6/IL-10比值较其他3组明显升高(P<0.05)。结论新生大鼠VILI与潮气量大小和通气时间有关,过度通气可导致严重肺损伤。肺组织IL-6水平与肺损伤程度呈正相关,致炎-抑炎因子失衡是VILI生物伤机制之一。
Objective To investigate the clinical characteristics of ventilator-associated lung injury (VILI) in neonatal rats with different tidal volume. Methods 32 newborn rats. They were randomly divided into control group (no ventilation), normal ventilation group (tidal volume 0.010 L.kg-1, ventilation for 5 h), hyperventilation 5 h group (tidal volume 0.025 L.kg-1, ventilation for 5 h) and hyperventilation 3 h group (tidal volume 0.025 L.kg-1, aeration 3 h). The lung mass was measured after mechanical ventilation, the lung coefficient was calculated, the pathological changes were observed, the lung injury scores were scored, and the levels of IL-6 and IL-10 in lung tissue were detected by ELISA. Results The pathological scores of lung injury in routine ventilation group and control group were (9.63 ± 1.40) points, (4.40 ± 1.06) points, (6.50 ± 1.85) points and 0.00 points, 4 The difference between the two groups was statistically significant (P = 0.000). The levels of IL-6 in the lung tissue of the normal ventilation group and the control group were (785.33 ± 39.06) pg.g-1, (656.78 ± 48.82) pg.g-1, ± 33.65) pg.g-1 and (635.02 ± 65.78) pg.g-1, 4, respectively. The difference was statistically significant (P = 0.000). Lung tissue IL-6 levels and lung injury score was positively correlated (r = 0.78, P <0.01). There was no significant difference in the levels of IL-10 among the groups (P = 0.940). The ratio of IL-6 / IL-10 in hyperventilation 5 h group was significantly higher than the other 3 groups (P <0.05). Conclusion Neonatal rats VILI and tidal volume and ventilation time, hyperventilation can lead to severe lung injury. The level of IL-6 in lung tissue is positively correlated with the degree of lung injury, and the imbalance of proinflammatory-proinflammatory cytokines is one of the mechanisms of VILI bio-injury.