【作者】 吴刚明；

【导师】 闵苏；

【作者基本信息】 重庆医科大学 ， 麻醉学， 2008， 硕士

【摘要】 目的观察全身麻醉下人工液胸辅助高强度聚焦超声（HIFU）辐照羊肝时动脉血气变化以及血浆和BALF中炎性细胞因子变化、肺内炎性反应情况并初步探讨作用机制。方法1～2岁雄性南江黄羊25只,随机分为空白对照组（C）、全麻组（A组）、全麻+人工液胸组（B组）、全麻+HIFU组（H组）、全麻+人工液胸+HIFU组（D组）,每组5只。动物全麻后,B、D组在右侧腋前线第4至6肋间隙进行穿刺,注入10ml/kg生理盐水,建立人工液胸。C、D组采用HIFU对肝膈项部进行辐照。分别于人工液胸建立前即刻（T₀）、建立后即刻（T₁）、30min后（HIFU治疗开始）（T₂）、1h（T₃）、2h（T₄）和4h（T₅）监测并记录除C组外的气道压。并于人工液胸建立前（全麻插管后即刻）（T_a）、建立2h后（T_h）和4h（T_c）行动脉血气分析同时采集静脉血。实验4h后处死动物,开胸取右肺下叶并行支气管肺泡灌洗,收集BALF。测定肺组织髓过氧化物酶（MPO）活性、丙二醛（MDA）含量、谷胱甘肽过氧化物酶（GSH-PX）和乳酸脱氢酶（LDH）活性并计算肺湿重/干重（W/D）比值,采用ELISA法测定血浆和BALF中IL-6和TNF-α浓度,同时取肺组织做光镜检查。结果C组除外,T₁～T₅各时点,B、D组与A、H组比较气道压均上升（P＜0.05）;B、D两组组内T₁～T₅时点与T₀时点相比气道压均上升（P＜0.05）。动脉血气结果显示,在Ta时点,与C组相比,A、H、B、D四组动脉血PH值和PO₂均降低,PCO₂升高（P＜0.05）;在T_b和T_c时点,A、H、B、D四组与C组比较,动脉血PH和PCO₂差异均无统计学意义（P＞0.05）,而PO₂升高（P＜0.05）;组内比较:A、H、B、D四组T_b、T_c与T_a时点分别相比,动脉血PH、PO₂均升高,PCO₂下降（P＜0.05）。与C、A、H三组分别比较,B组和D组肺组织MDA含量、MPO、LDH活性和W/D比值均升高,GSH-PX活性下降,差异有统计学意义（P＜0.05）。与C、A、H三组分别比较,B、D组BALF中IL-6、TNF-α和蛋白含量均上升（P＜0.05）。T_b和T_c时点,B、D、H三组与C、A组分别比较,血浆中IL-6、TNF-α含量均上升（P＜0.05）,且在T_c时点,H与B组,D组与H、B组分别比较,血浆中IL-6、TNF-α含量均上升（P＜0.05）;H、B、D三组组内,T_b与T_a时点,T_c与T_a～b时点分别相比,血浆IL-6、TNF-α含量均上升（P＜0.05）。病理学结果显示:B、D组可见肺组织充血明显,肺泡腔有大量炎症细胞浸润,可见出血和渗出。结论全身麻醉下人工液胸辅助HIFU辐照羊肝时对肺产生一定程度的损伤,且随时间的延长损伤逐渐加重;全身麻醉、全身麻醉复合HIFU对肺未见明显损害。全麻下人工液胸对肺的通气弥散功能无明显影响,全麻下人工液胸辅助HIFU辐照羊肝是安全可行的。更多还原

【Abstract】 Objective To investigate the changes of arterial blood gas, plasmas and BALF content of inflammatory cytokine and lung inflammatory reaction,and to explore its possible mechanisms via the artificial hydrothorax under general anesthesia in aid of high intensity focusing ultrasound irradiated goats liver.Methods Twenty-five male Nan-Jiang yellow goats weighing 14.5～24kg were randomly divided into five groups（n=5 each）:control group（group C）;general anesthesia（group A）;general anesthesia and artificial hydrothorax（group B）;general anesthesia and HIFU（group H）; general anesthesia,artificial hydrothorax and HIFU（group D）.After general anesthesia,artificial right hydrothorax was created by instilling 10ml/kg normal saline at the right anterior axillary line of the fourth to sixth intercostals space in group B and D.The livers in the hepatic diaphragmatic dome were irradiated by HIFU in group H and group D.The pressures of airway were monitored and recorded,before created artificial hydrothorax（T₀）,at the moment of created artificial hydrothorax（T₁）,at the moment of HIFU irradiated after artificial hydrothorax built 30min（T₂）,1, 2 hours after artificial hydrothorax built（T₃,T₄）and at the end of the experiment（T₅）.Arterial blood gas was monitored and vein blood samples were obtained at different stage of experiment:before created artificial hydrothorax（at the moment of tracheal intubation）（T_a）,after created artificial hydrothorax 2 hours later（T_b）,and at the end of the experiment（T_c）. The animals were killed at the end of 4h experiment,the lung was immediately removed for bronchoalvelolar lavaged and collected BALF and determination of MDA content,MPO and GSH-PX and LDH activities, determination weight of wet/dry ratio of lung,a sandwich ELISA was used to determine plasmas and bronchoalveloar lavage fluid interleukin-6 and TNF-αcontent,and light microscope examination for the degree of lung damage of pathology.Results Except group C,at T₁～T₅,the pressure of airway was higher in group B and group D than in group A and group H（P＜0.05）.The pressure of airway was higher in group B and group D at T₁～T₅ than T₀（P＜0.05）.At T_a,the PH and PO₂ in arterial blood were lower and the PCO₂ was higher in group A,H,B and D than in control group（P＜0.05）. But there were no obviously differences in PH,PO₂ and PCO₂ almong all groups at T_b～T_c（P＞0.05）;the PH and PO₂ of arterial blood were higher and the PCO₂ was lower in group A,H,B and group D at T_b～T_c than T_a （P＜0.05）.The MPO and LDH activity,MDA content and Wet/Dry ratio of lung weight ratio were higher and the GSH-PX activity was lower in the lung tissue in group B and group D than in control group,group A and group H（P＜0.05）,there were no significant differences in these variables between group B and D（P＞0.05）.The content of bronchoalveloar lavage fluid interleukin-6,TNF-αand protein were higher in group B and group D than in control group,group A and group H（P＜0.05）.In group comparison, at T_b,the content of blood plasma interleukin-6 and TNF-αwere higher in group B,D and group H than in group A and group C（P＜0.05）,the content of blood plasma interleukin-6 and TNF-αwere higher in group B,D and H than group A and C,in group H than group B,in group D than group B and H at T_c（P＜0.05）.The content of blood plasma interleukin-6 and TNF-αwas higher in group B,H and D at T_b～T_c than T_a,T_c than T_a～b（P＜0.05）.In group B and D,the lung tissues were obviously congested,the lung tissues and alveolar space were infiltrated by a large number of inflammatory cells and neutrophils.Conclusion Artificial hydrothorax in aid of HIFU irradiated goats liver in vivo could cause some injury to lung.With the extension of time, artificial hydrothorax induced more serious lung injury,there was no effective injury to lung by anesthesia and by HIFU under general anesthesia.Artificial hydrothorax under general anaesthesia hadn’t distinct influence on the venting and diffusion function of lungs,though artificial hydrothorax itself caused some injury to lungs,which shows that it is safe for artificial hydrothorax on lung under general anesthesia in aid of high intensity focusing ultrasound irradiated goats liver.更多还原