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中华卫生应急电子杂志 ›› 2016, Vol. 02 ›› Issue (06) : 350 -357. doi: 10.3877/cma.j.issn.2095-9133.2016.06.004

所属专题: 专题评论 文献

论著

密闭舱室烟雾吸入性肺损伤救治方案效果评价
孙磊1, 陈晟1, 蔡颖1, 安辉1, 敖琳1, 杨桓1, 陶成玉2, 刘晋祎1, 曹佳1,()   
  1. 1. 40038 重庆,第三军医大学毒理学研究所
    2. 233010 蚌埠,解放军装甲兵学院门诊部
  • 收稿日期:2016-11-25 出版日期:2016-12-18
  • 通信作者: 曹佳
  • 基金资助:
    全军部队卫生和疾病防控应用性研究指令性课题(13BJYZ28)

Evaluation on the effect of therapeutic measures to acute lung injury induced by smoke inhalation in airtight cabins

Lei Sun1, Sheng Chen1, Ying Cai1, Hui An1, Lin Ao1, Huan Yang1, Chengyu Tao2, Jinyi Liu1, Jia Cao1,()   

  1. 1. Institute of toxicology; Third Military Medical University, Chongqing 400038, China
    2. Department of ambulant clinic, PLA Academy of armored forces, Bengbu 233010, China
  • Received:2016-11-25 Published:2016-12-18
  • Corresponding author: Jia Cao
  • About author:
    Corresponding author: Cao Jia, Email:
引用本文:

孙磊, 陈晟, 蔡颖, 安辉, 敖琳, 杨桓, 陶成玉, 刘晋祎, 曹佳. 密闭舱室烟雾吸入性肺损伤救治方案效果评价[J]. 中华卫生应急电子杂志, 2016, 02(06): 350-357.

Lei Sun, Sheng Chen, Ying Cai, Hui An, Lin Ao, Huan Yang, Chengyu Tao, Jinyi Liu, Jia Cao. Evaluation on the effect of therapeutic measures to acute lung injury induced by smoke inhalation in airtight cabins[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2016, 02(06): 350-357.

目的

评价不同救治方案对密闭舱室烟雾吸入性肺损伤的救治效果。

方法

将78只清洁级雄性SD大鼠完全随机分为13组,每组6只,分别为正常对照组(A组)、损伤对照组(B组)及救治组(C~M组),其中B~M分别进行烟雾吸入染毒10 min,C~E组分别行30%、60%、100%浓度常压氧吸入;F和G组分别给予10 U/mL和50 U/mL肝素钠雾化吸入;H和I组为5 mg/kg地塞米松(Dex)预处理及染毒后治疗;J和K组为1 000 mg/kg维生素C预处理及染毒后治疗;L和M组为200 mg/kg N-乙酰半胱氨酸(NAC)预处理及染毒后治疗。观察烟雾吸入后24 h,各组大鼠的动脉血气分析[酸碱度(pH)、动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)]、静脉血碳氧血红蛋白(COHb)及其清除率(CCR)、肺组织病理改变及评分、肺湿干重比值(W/D)、肺泡灌洗液(BALF)和血清总蛋白浓度、肺通透性指数(PPI)、肺组织谷胱甘肽-过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量及血清一氧化氮(NO)含量等指标的改变,综合评价各种措施的救治效果。

结果

烟雾吸入后24 h,与B组比较,D、E、G、H组PaO2显著升高[(117.0±1.0) mmHg,(119.2±3.1) mmHg,(115.0±5.7) mmHg,(101.8±3.3) mmHg vs (89.1±1.5) mmHg,P<0.05],J组大鼠PaO2显著降低[(69.4±2.8) mmHg vs (89.1±1.5) mmHg,P<0.05];与B组比较,C、D和E组CCR显著升高[(23.1±4.2)%/h,(24.0±4.9)%/h,(26.3±4.5)%/h vs (19.3±2.2)%/h,P<0.05];与B组比较,G、H、L和M组大鼠的肺损伤总评分均显著低于B组[(2.9±1.0),(5.0±0.4),(4.4±1.5),(5.9±1.4) vs (9.4±1.2),P<0.05];与B组比较,C、G、H和I组大鼠肺W/D均显著降低[(4.63±0.10),(4.62±0.06),(4.65±0.05),(4.57±0.12) vs (4.88±0.21),P<0.05];与B组比较,H组肺PPI指数显著下降[(2.42±0.38) vs (7.02±1.05),P<0.01];与B组比较,J、L和M组大鼠肺组织GSH-Px和SOD活性均显著升高(P<0.05)、肺组织MDA和NO含量均显著降低(P<0.05)。

结论

分别使用100%常压氧吸入、高剂量肝素钠雾化吸入、地塞米松预处理及NAC预处理,均能对密闭舱室火灾烟雾吸入性肺损伤有较明显的治疗效果。

Objective

To screen and evaluate the therapeutic effects of various treatment on acute lung injury induced by smoke inhalation in airtight cabins.

Methods

78 male SD rats were randomly divided into control group (group A), injury group (group B) and eleven treatment groups (group C~M) with 6 rats in each group. Group B~M were exposed in smoke for 10 min, and C~M groups respectively treated with 30%, 60% and 100% normal pressure oxygen inhalation, heparin sodium atomization, injection of dexamethasone(Dex), vitamine C or N acetyl cysteine (NAC). Blood gas, Carboxyhemoglobin(COHb) and COHb clearance rate (CCR), lung pathological changes, lung wet-to-dry weight ratio (W/D), pulmonary permeability index (PPI), glutathione peroxidase(GSH-Px), superoxide dismutase(SOD) activity and the content of malondialdehyde(MDA) and nitric oxide(NO) were measured at 24h post-exposure to evaluate the effects of various therapeutic measures.

Results

Compared with the group B, the PaO2 in the group D, E, G and H were increased significantly [ (117.0±1.0) mmHg, (119.2±3.1) mmHg, (115.0±5.7) mmHg, (101.8±3.3) mmHg vs (89.1±1.5) mmHg, P<0.05, respectively]. Compared with the group B, the CCR in the group C, D and E were increased significantly [ (23.1±4.2)%, (24.0±4.9)%, (26.3±4.5)% vs (19.3±2.2)%, P<0.05, respectively]; lung pathological score in the group G, H, L and M was decreased significantly compared with that in the group B [ (2.9±1.0), (5.0±0.4), (4.4±1.5), (5.9±1.4) vs (9.4±1.2), P<0.05, respectively]; lung wet-to-dry weight ratio in the group C, G, H and I were decreased significantly compared with that in the group B [(4.63±0.10), (4.62±0.06), (4.65±0.05), (4.57±0.12) vs (4.88±0.21), P<0.05, respectively]; PPI in the group H was significantly lower than that in the group B [ (2.42±0.38) vs (7.02±1.05), P<0.01]. Compared with the group B, the activity of GSH-Px and SOD significantly increased (P<0.05) and the content of MDA and NO significantly decreased (P<0.05) in the group J, L and M.

Conclusion

100% normal pressure oxygen inhalation, high dose of heparin sodium nebulization, dexamethasone or NAC pretreatment may have a better therapeutic effect on the acute lung injury induced by smoke inhalation in airtight cabins.

图1 不同救治措施处理烟雾吸入后24h大鼠动脉血气分析结果
图2 不同救治措施处理烟雾吸入后20 min、80 min时大鼠静脉血COHb%及其CCR比较
图3 不同救治措施处理烟雾吸入后24 h大鼠肺组织损伤评分比较
图4 不同救治措施处理烟雾吸入后24h大鼠肺水含量比较
表1 不同救治措施组大鼠烟雾吸入后24 h BALF及血清中总蛋白浓度的变化
图5 不同救治措施组大鼠烟雾吸入后24h肺组织GSH- Px、SOD活性级血清MDA含量的变化
图6 不同救治措施处理烟雾吸入后24 h大鼠血清NO含量变化
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