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 mmHg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PaO2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、PaO2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、PaO2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、PaO2、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。%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 concentrations and pathological scores were decreased significantly , MAP, PaO2 and oxygenation index were increased obviously in groups A and C .Compared with group C , Lac concentrations were decreased obviously while no significant changes were found in the other parameters in group A ( all P<0 .05 ) .Conclu-sion Three different fluids of volume resuscitation can induce LPS-induced lung injury , and hypertonic sodium chloride hydroxyethyl starch 40 solution presents more effectively than the remaining two and it could be involved in the mechanism of maintaining the mount of SP-D in lung and regulating the anti-inflammation of SP-D and thus reducing the inflammatory response in the lung tissues .
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