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目的探讨通气相关肺损伤(ventilator induced lung injury,VILI)中的肺部炎症反应和肺内血管紧张素Ⅱ的关系,并研究血管紧张素转换酶抑制剂(卡托普利)在大鼠通气相关肺损伤模型中的作用。方法将21只雄性SD大鼠分成3组:高潮气量、零呼气末正压(HVZP)组;卡托普利治疗组(HVZP+CAP)组;空白对照组。行动脉插管和气管插管后测定动脉血气分析和平均动脉压,同时测定支气管肺泡灌洗液中的总蛋白数、巨噬细胞炎性蛋白-2(MIP-2)的浓度及肺组织血管紧张素Ⅱ的水平,并观察肺组织形态学的变化。结果HVZP+CAP组大鼠的平均动脉压明显低于HVZP组(P<0.05)。HVZP大鼠肺泡灌洗液中的总蛋白水平明显高于对照组(P<0.05),且灌洗液中的MIP-2和肺血管紧张素Ⅱ明显高于对照组和HVZP+CAP组(P<0.05)。肺血管紧张素Ⅱ的水平与肺泡灌洗液中的蛋白水平和MIP-2的水平呈正相关。结论卡托普利通过下调炎症因子可以降低机械通气中肺损伤的程度,机械通气相关肺损伤的发生与肺部的血管紧张素系统相关。
Objective To investigate the relationship between pulmonary inflammatory response and pulmonary angiotensin Ⅱ in ventilator - induced lung injury (VILI) and the relationship between angiotensin Ⅱ converting enzyme inhibitor (captopril) Role in lung injury model. Methods Twenty-one male Sprague Dawley rats were divided into 3 groups: high tidal volume, positive zero-expiratory pressure (HVZP) group, captopril-treated group (HVZP + CAP) and blank control group. Arterial blood gas analysis and mean arterial pressure were measured after arterial intubation and endotracheal intubation. Meanwhile, the total number of proteins in bronchoalveolar lavage fluid, the concentration of macrophage inflammatory protein-2 (MIP-2) The level of T II and the change of lung histomorphology. Results The mean arterial pressure of HVZP + CAP group was significantly lower than that of HVZP group (P <0.05). The total protein level of alveolar lavage fluid in HVZP rats was significantly higher than that in control group (P <0.05), and the levels of MIP-2 and pulmonary angiotensin II in lavage fluid were significantly higher than those in control group and HVZP + CAP group <0.05). The level of pulmonary angiotensin II was positively correlated with the level of protein in bronchoalveolar lavage fluid and the level of MIP-2. Conclusions Captopril can reduce the degree of lung injury during mechanical ventilation by down-regulating inflammatory cytokines. The occurrence of mechanical ventilation-related lung injury is related to the pulmonary angiotensin system.