中文摘要：

目的观察不同液体容量复苏对大鼠内毒素性急性肺损伤(ALI)的防治作用,并探讨其可能机制。方法将50只健康雄性SD大鼠随机分为5组各10只,A、B、C、D组制备内毒素性ALI模型,以氧合指数≤300 mm Hg时为模型制备成功;E组不制备模型。模型制备成功后开始液体容量复苏,并将此时作为零时,A组经股静脉注入高渗氯化钠羟乙基淀粉40溶液、B组注入氯化钠溶液、C组注入6%羟乙基淀粉130/0.4溶液,D组不注入任何液体,E组注入等容量生理盐水。观察注射内毒素前及注射内毒素1、3、6 h平均动脉压(MAP)变化;并于液体复苏后6 h采集大鼠股动脉血,用ELISA法检测血清TNF-α和肺表面活性蛋白D(SP-D),并行血气分析,记录Pa O2和乳酸(Lac)水平,计算氧合指数;随后处死大鼠,取肺组织,测定肺湿干重(W/D)值;HE染色观察肺组织病理学变化;按照Mikawa的方法进行肺损伤评分。结果与E组比较,A、B、C、D组W/D值、肺损伤评分及TNF-α、SP-D、Lac水平升高,MAP、Pa O2和氧合指数降低;与D组比较,A、B、C组W/D值、肺损伤评分及TNF-α、SP-D、Lac水平降低,MAP、Pa O2和氧合指数升高;与B组比较,A、C组W/D值、肺损伤评分、TNF-α、SP-D、Lac水平降低,MAP、Pa O2、氧合指数升高;与C组比较,A组Lac水平降低;P均<0.05。结论高渗氯化钠羟乙基淀粉40溶液、氯化钠溶液、6%羟乙基淀粉130/0.4溶液三种液体容量复苏均能有效减轻大鼠内毒素性ALI,且高渗氯化钠羟乙基淀粉40溶液效果较其余两种更显著,其机制可能与维持肺内SP-D水平、调节SP-D抗炎作用从而减轻机体炎症反应有关。

英文摘要：

Objective To investigate the preventive and therapeutic effects of volume resuscitation with different flu -ids on acute lung injury ( ALI) induced by lipopolysaccharide ( LPS) and to discuss the mechanism .Methods Fifty male Sprague-Dawley ( SD) rats were randomly divided into five groups with 10 animals in each group:group A, group B, group C, group D (in those four groups, ALI rats models were induced by intravenous LPS when PaO 2/FiO2≤300), and group E (rats were not induced).Hypertonic sodium chloride hydroxyethyl starch 40 solution, sodium chloride injection and 6%hydroxyethyl starch 130/0.4 solution were infused into rats of group A , group B and group C correspondingly after PaO 2/FiO2≤300mmHg.Group E was infused with the same amount of saline solution .Group D was not injected with any solu-tion.When we started intravenous different fluids , the time was regarded as 0 h.Observing the changes of MAP at pre-in-travenous LPS, 1 h, 3 h and 6 h.At 6 h after volume resuscitation , the blood samples were collected from the femoral ar-tery, and then the serum tumor necrosis factor-α( TNF-α) and surfactant protein-D ( SP-D) concentrations were analyzed by ELISA as well as the blood gas analysis .PaO2 and lactate ( Lac) concentrations were recorded and oxygenation index (PaO2/FiO2) was calculated.After 6 hours, the rats were killed.The lung was removed for determining wet/dry (W/D) weight ratio and for microscopic examination of pathologic changes of lung tissues which were stained by HE staining , and scored according to Mikawa .Results Compared with group E , W/D ratio, serum TNF-α, SP-D, Lac concentrations and pathological scores were increased significantly , MAP, PaO2 and oxygenation index were decreased obviously in groups A , B, C and D.Compared with group D , W/D ratio, serum TNF-a, SP-D, Lac concentrations and pathological scores were decreased significantly , MAP, PaO2 and oxygenation index were increased obviously in groups A , B and C.Compared with group B, W/D ratio, serum TNF-a, SP-D, Lac conc