摘要
目的通过比较不同剂量地塞米松对海水淹溺型急性肺损伤(SWD-ALI)的治疗作用,探讨地塞米松的应用价值并选择理想的治疗剂量。方法健康成年新西兰兔28只,用随机数字表法均分为4组:S组(制作SWD-ALI模型后不做任何处理)及D0.5组、D1组、D5组(制作SWD-ALI模型后,分别经耳缘静脉注入地塞米松磷酸钠0.5、1.0、5.0mg/kg)。分别观察各组灌注前、灌注即刻(0min)及灌注后30、60、120、180min时的呼吸频率、动脉血气及部分时间点血清TNF-α水平,于实验终点测定血清总蛋白含量,并进行肺组织病理学检查,测定肺湿/干重比、肺微血管通透指数。结果海水灌注后各组动物均出现呼吸频数,D5组出现四肢阵挛;与S组比较,各地塞米松治疗组PaO2、PaCO2及BE均轻度改善,支气管肺泡灌洗液(BALF)中细胞总数及中性粒细胞比例均明显减少(P<0.01),肺组织湿/干重比、肺微血管通透指数、肺组织病理评分及TNF-α表达水平均显著减低(P均<0.01),除TNF-α水平下降以D5组为著外,其余各项指标改变均以D0.5组最为显著。结论地塞米松治疗可有效改善低氧血症,减轻肺水肿和肺损伤程度,降低肺微血管通透性,减轻炎症反应,并且以小剂量使用更为安全有效。
Objective To explore the desirable dosage of dexamethasone （DM） by comparison of the therapeutic effects of different dosages of DM on the seawater drowning-induced acute lung injury （SWD-ALI） in rabbits. Methods SWD-ALI model was established in twenty-eight healthy New Zealand rabbits, and they were randomly allocated to 4 groups by using a random number table. Animals of D0. 5, D1 and D6 group were given DM with the dosage of 0. 5, 1 and 5 mg/kg, respectively, while of S group were given on treatment. Respiratory rate and blood gas analysis were recorded before DM administration, the immediately after administration, and 5, 30, 60, 120 and 180 min after giving DM, and the serum level of TNF-α was determined at some of the time points. Total serum proteins were measured, pathologic changes were observed, and wet-to-dry lung weight ratio and lung permeability index were calculated at the termination of the experiment. Results Tachypnea appeared in all the animals after seawater drowning, but spasmodic attacks appeared only in the D5 group. Compared with that of S group, the levels of PaO2, PaCO2 and BE were slightly ameliorated, the total cell counts and the proportion of neutrophil decreased significantly （P〈0. 01）, wet-to-dry ratio of lung tissue, lung permeability index, pathologic scores and TNF- α level also decreased remarkably （P〈0. 01） in all the DM treatment groups. Conclusions Dexamethasone, especially in a low dosage, may improve the hypoxemia effectively, ameliorate pulmonary edema and lung injuries, decrease the pulmonary capillary permeability and alleviate inflammatory reaction.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2009年第7期815-818,共4页
Medical Journal of Chinese People's Liberation Army
基金
全军"十一五"后勤科研计划课题(06-3305)
关键词
地塞米松
淹溺
接近
海水
急性肺损伤
dexamethasone
near drowning
seawater
acute lung injury
