目的 研究高压氧(hyperbaric xygen,HBO)是否对油酸诱导兔急性呼吸窘迫综合征( acute respiratory distress syndrome,ARDS)有肺保护作用.方法 成年健康新西兰大白兔36只,按随机数字表法分为正常对照(N)组、ARDS(A)组、ARDS常规治疗60 min(M60)组、ARDS常规治疗120 min(M120)组、ARDS HBO治疗60 min(O60)组和ARDS HBO治疗120 min(O120)组.M60组和M120组为兔制备ARDS模型后接氧气吸入治疗60 min和120 min;O60组和O120组分别为兔制备ARDS模型后,给予HBO治疗在2.5 atm(1 atm=101.325 kPa)下接氧气吸入(氧流量5 L·min-1)治疗60 min和120 min.同时在相应时相点取颈内动脉血检测动脉血氧分压(PaO2)、pH和乳酸;留取右肺支气管肺泡灌洗液测定肺表面活性物质相关蛋白A(SP-A)、白细胞介素-l(IL-1)、肿瘤坏死因子-α(TNF-α);取左肺标本计算肺湿重/干重(W/D)比值及肺组织病理学分析.结果 1)与N组比较,M60、M120组PaO2均下降,呈进行性加重的状态(P＜0.05),但经过HBO治疗的O60、O120组PaO2值有明显上升(P＜0.05);与N组相比,M60、M120、O60、O120组pH值明显下降(P＜0.05);M60、M120、O60、O120组乳酸值较N组都有不同程度的增加,M60、M120组随着时间延长各组数值逐渐增高(P＜0.05),经过HBO治疗后,乳酸值O60、O120组较M60、M120组有明显下降(P＜0.05).2)O60、O120组较M60、M120组肺泡灌洗液中SP-A值有明显上升(P<0.05);肺泡灌洗液中IL-1、TNF-α值在O120组较M60、M120组有显著下降(P<0.05).3)M组和O组肺W/D随时间的延长而增加,与M60组相比,O60组W/D无显著性差异(P＞0.05),O120组有明显下降(P＜0.05).4)病理:O60组兔肺组织切片较M60、M120组见肺间质水肿有所减轻,O120组与M60、M120组相比水肿、出血、渗出进一步改善.结论 HBO对兔ARDS有明显保护作用.%Objective To investigate the protection effect of hyperbarie oxygen (HBO ) therapy on acute respiratory distress syndrome (ARDS) induced by oleic acid in rabbits .Methods Thirt-six healthy adult New Zealand rabbits were randomly divided into six groups : normal control (group N ) ,ARDS (group A ) conventional treatment for 60 minutes (group M60 ) conventional treatment for 120 minutes (group M120 ),HBO treatment for 60 minutes (group O60 ) and HBO treatment for 120 minutes (group O120 ) .Rats in group M60 and group M120 were treated with oxy-rngen inhalation for 60 and 120 minutes after ARDS induction respectively .Rats in group O60 and group O120 were given HBO therapy at 2 .5 atm (1 atm=101 .325 kPa) followed by oxygen inhalation for 60 and 120 minutes respectively .At the same time ,blood samples were taken from the carotid artery to detect PaO2 ,pH value and lactate concentrations .Lung bronchoalveolar lavage fluid was obtained to measure surfactant protein A (SP-A ) ,interleukin-1 (IL-1 ) and tumor necrosis factor-α(TNF-α) levels .Left lung specimens were collected to calculate wet-to-dry weight (W/ D) ratio and to observe histopathological changes .Results Compared with group N ,PaO2 value significantly decreased and showed a progressive reduction in group M so and group M120 ,but significantly increased in group O60 and group O120 (P<0 .05) .Compared with group N ,pH value obviously decreased and lactate concentrations obviously increased in group M60 ,group M120 ,group O60 and group O120 ( P<0 .05 ) .Furthermore ,lactate concentrations gradually increased with time in group M60 and group M120 (P<0 .05 ) .Compared with conventional treatment , HBO therapy for 60 and 120 minutes significantly decreased concentrations of lactate in arterial blood and levels of IL-1 and TNF-α in bronchoalveolar lavage fluid but obviously increased levels of SP-A in bronchoalveolar lavage fluid ( P<0 .05 ) . W/D ratio increased with time in group M and group O . Compared with group M60 ,W/D ratio obviously decreased in group O120 ( P<0 .05) .But no significant differences were found between group Meoand group O60 (P>0 .05 ) .Compared with conventional treatment ,pulmonary interstitial edema was significantly reduced by HBO therapy for 60 minutes and edema,bleeding and exudation were obviously improved by HBO therapy for 120 minutes .Conclusion HBO therapy plays a protective role in ARDS .
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