作　　者： (黄强）; (夏明珠）; (石伟）; (王萍）; (姜远旭）;

机构地区： 深圳市人民医院麻醉科,深圳市麻醉医学工程研究中心,广东深圳518020

出　　处： 《中国急救医学》 2017年第9期821-826,F0003,共7页

摘　　要： 目的 研究右美托咪定（dexmedetomidine， DEX）联合地塞米松（dexathasone， DXM）对单肺通气（one lung ventilation， OLV）大鼠肺毛细血管通透性的影响。方法 清洁级雄性SD大鼠80只,随机分成五组：生理盐水对照组（NS组）、OLV组（O组）、地塞米松治疗组（O＋D组）、右美托咪定治疗组（O＋E组）、右美托咪定联合地塞米松治疗组（O＋D＋E组）,每组16只。NS组大鼠行双肺通气2.5 h，通气后即刻静脉给予0.1 mg/kg生理盐水及静脉持续输注0.5 μg/（kg·h）生理盐水；O组右肺通气2.0 h，双肺通气0.5 h，通气后即刻静脉给予0.1 mg/kg生理盐水及静脉持续输注〖JP.5 μg/（kg·h）生理盐水；O＋D组右肺通气2.0 h，双肺通气0.5 h，通气后即刻静脉给予0.1 mg/kg地塞米松及静脉持续输注0.5 μg/（kg·h）生理盐水；O＋E组右肺通气 2.0h，双肺通气0.5 h，通气后即刻静脉给予0.1 mg/kg生理盐水及静脉持续输注0.5 μg/（kg·h）右美托咪定；O＋D＋E组右肺通气2.0 h，双肺通气0.5 h，通气后即刻静脉给予地塞米松（0.1 mg/kg）及静脉持续输注0.5 μg/（kg·h）右美托咪定。NS组双肺通气2.5 h其余各组于双肺通气0.5 h处死大鼠。动脉血气检测氧分压（PaO2）；检测肺湿干质量比（W/D）及髓过氧化物酶（MPO）活性；光镜下观察肺组织病理学变化；检测支气管肺泡灌洗液（BALF）中总细胞数及总蛋白含量；ELISA检测肺组织TNF-α、IL-1β、一氧化氮（NO）、前列腺素E2（PGE2）的含量；RT-PCR检测肺组织一氧化氮合酶（iNOS）及环氧化物酶2（COX2）的表达；伊文思蓝染检测大鼠肺毛细血管通透性。结果 与NS组比较，O组PaO2降低，W/D、MPO 活性升高；与O组比较，O＋D＋E组PaO2升高，W/D、MPO 活性降低（P〈0.01），而O＋D和O＋E组差异无统计学意义（P〉0.05）。与NS组比较，O组BALF中总细胞数、总蛋白含量升高（P〈0.01）；与O组比� Objective To investigate effects of dexmedetomidine -dexamethasone combination on membrane permeability of alveolar capillaries in one lung ventilation rats. Methods Male SD rats （n = 80） were randomly divided into five groups（ n = 16） ： normal saline control group（ NS group）, OLV group（ O group）, OLV - dexamethasone group（ 0 ＋ D group）, OLV - dexmedetomidine group （ O ＋ E group）, OLV - dexmedetomidine - dexamethasone group （O ＋ D ＋ E group ）. Bilateral lung were ventilated for 2.5 h in NS group and were treated with saline（0.1 mg/kg, iv） followed by an infusion of 0.9% normal saline 0.5 μg/（ kg·h） immediately after ventilation. The right lung was ventilated for 2.0 h followed by 0.5 h two lung ventilation in O group and were treated with normal saline （0.1 mg/ kg iv） followed by an infusion of 0.9% normal saline [0.5 μg/（ kg · h） ] immediately after ventilation. The right lung was ventilated for 2.0 h followed by 0.5 h two lung ventilation in O ＋ D group and were treated with dexamethasone（0.1 mg/kg, iv） followed by an infusion of 0.9% normal saline [0.5μg/ （ kg· h） ] immediately after ventilation. The right lung was ventilated for 2.0 h followed by 0.5 h two lung ventilation in O ＋ E group and were treated with 0.9% normal saline（0.1 mg/kg, iv） followed by an infusion of dexmedetomidine [0.5μg/（ kg ·h） ] immediately after ventilation. The right lung was ventilated for 2.0 h followed by 0.5 h two lung ventilation in O ＋ D ＋ E group and were treated with dexamethasone（ 0. 1 mg/kg, iv） followed by an infusion of dexmedetomidine [ 0.5 μg/（ kg · h）] immediately after ventilation. The animals were sacrificed and 1 mL arterial blood was collected to determine the PaO2. Their lungs were removed for evaluating histological characteristics and determining the lung wet/dry weight ratio（W/D） and MPO activity. The protein concentrations, total cell counts in bronchoalveolar lavage fluid （BALF） were obtained. The expressio

关 键 词： 单肺通气 右美托咪定 地塞米松 血气屏障 一氧化氮合酶 环氧化物酶