左西蒙旦联合精氨酸加压素对脓毒血症猪急性肺损伤的影响
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江苏省“六大人才高峰”课题(2008093);常州市卫生局科技计划项目(WZ201044)


Effects of levosimendan combined with vasopressin on sepsis-induced lung injury in swine
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    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[0.4 -滋g/(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--琢-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--琢降低(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-

    Abstract:

    Objective: To investigate the effects of levosimendan(LS) combined with arginine vasopressin(AVP) on sepsis-induced lung injury(ALI) in swine. Methods: Fourteen female pigs were anesthetized and mechanically ventilated,and then peritonitis model was established. When mean arterial pressure (MAP) decreased to less than 60 mmHg,animals were randomly assigned to two groups: norepinephrine (NE) or LS (fixed dose of 0.4 -滋g/kg/min) + AVP (fixed dose of 0.57 mU/kg/min). If necessary,NE was titrated to maintain MAP between 65 and 75 mmHg in both groups. MAP,mean pulmonary artery pressure (MPAP),pulmonary capillary wedge pressure(PCWP),atrial oxygen saturation (SaO2),mixed venous saturation (SvO2),lactate concentration,hemoglobin concentration (Hb),cardiac output (CO),and plasma levels of TNF--琢,IL-6,IL-10,and NOax were determined at the following time points:before the establishment of sepsis model (baseline,T1),shock time(T2),and 6 h(T3) and 12 h(T4) after shock. Qs/Qt(venous admixture) was calculated at these time points. Time to the onset of septic shock point,total NE and fluid requirements were also recorded. Lung was removed for the determinations of pulmonary wet-to-dry ratio(W/D),myeloperoxidase activity (MPO),histological changes and apoptotic cells. Results: MAP,PCWP,time to the onset of septic shock point,total fluid requirements and Hb had no significant differences between the two groups(P > 0.05). Compared with NE group,MPAP,Qs/Qt,lactate concentrations,plasma levels of IL-6,and NOax at T4 and plasma levels of TNF--琢,HR and CO at T3 were significantly lower,while SaO2 and SvO2 were higher in LS+AVP group(P < 0.05). Total NE requirements,lung tissue levels of MPO activity,W/D ratio,total histological scores,and positive apoptotic cells were significantly lower in the LS+AVP group than those in NE group (P < 0.05). Conclusion: Combined LS with AVP improves gas exchange,decreases MPAP and lung inflammatory responses when compared with NE infusion alone in a porcine model of sepsis-induced ALI.

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纪木火,吴 晶,李仁奇,刘芳芳,李国民,范云霞,杨建军.左西蒙旦联合精氨酸加压素对脓毒血症猪急性肺损伤的影响[J].南京医科大学学报(自然科学版),2011,(10):1444-1447

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  • 收稿日期:2011-05-11
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