目的 探討免疫增強(qiáng)型腸內(nèi)營(yíng)養(yǎng)對(duì)呼吸機(jī)所致肺損傷(VILI)大鼠炎癥反應(yīng)和免疫功能的影響。方法 40只大鼠隨機(jī)分為普通腸內(nèi)營(yíng)養(yǎng)組(EN組)和免疫增強(qiáng)型腸內(nèi)營(yíng)養(yǎng)組(SEN
組)，每組各20只，兩組中又分別設(shè)立正常條件通氣對(duì)照組(EN1 組和SEN1組)和致傷通氣組(EN2組和SEN2組)。腸內(nèi)營(yíng)養(yǎng)采用灌喂的方式進(jìn)行。于機(jī)械通氣0、4、24及72 h分別采集血液標(biāo)本，測(cè)定外周血CD3+ 、CD4+ 和CD8+ 淋巴細(xì)胞亞群，血漿TNF-α．和IL-6及紅細(xì)胞膜花生四烯酸(AA)的含量。所有大鼠于機(jī)械通氣72h后處死，取肺組織行HE染色觀察肺組織病理學(xué)變化。結(jié)果 (1) EN 組大鼠致傷通氣24及72 h的CD3+ 、CD4+ 、CD4+ ／CD8+ 較EN1組和SEN 1組明顯下降，差異有統(tǒng)計(jì)學(xué)意義(P lt;0.05)，而SEN2組略高于EN 1組和SEN1組，但差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。(2) 機(jī)械通氣4及24 h后，EN2組大鼠TNF-α和IL-6明顯升高，較其余3組有顯著差異(P lt;0.05)，72 h時(shí)EN2組有所下降，但仍較其他組高(P lt;0.05)。而EN1 組、SEN 1組及SEN2組間比較無(wú)顯著差異(P gt;0.05)。(3) 機(jī)械通氣后4、24、72 h時(shí)點(diǎn)EN2組大鼠紅細(xì)胞膜AA含量下降(P lt;0.05)，SEN2組接近正常水平與EN 組、EN 組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。結(jié)論 大鼠在致傷性機(jī)械通氣前給予免疫增強(qiáng)型腸內(nèi)營(yíng)養(yǎng)能減輕炎癥反應(yīng)，增強(qiáng)免疫功能，保護(hù)肺組織減輕損傷
引用本文： 冼樂(lè)武,梁宗安. 免疫增強(qiáng)型腸內(nèi)營(yíng)養(yǎng)對(duì)呼吸機(jī)所致肺損傷大鼠炎癥反應(yīng)及免疫功能的影響. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 08(6): 455-458. doi: 復(fù)制
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- 2. Held HD，Boettcher S，Hamann L，et al．Ventilation-induced chemokine and cytokine release is associated with activation of nuclear factor-kappa B and is blocked by steroids．Am J Respir Crit Care Med，2001，163：711-716．.
- 3. Karzai W ，Cui XZ，Heinicke N，et a1．Neutrophil stimulation with granulocyte c010nystimu1ating factor worsens ventilator-induced lung injury and mortality in rats．Anesthesiology，2005，103：996-1005．.
- 4. Copland IB．Post M．Stretch-activated signaling pathways responsible for early response gene expression in fetal lung epithlial ceils．J Cell Physiol，2007，210：1 33-143．.
- 5. 陳灝珠，主編．實(shí)用內(nèi)科學(xué)．北京：人民衛(wèi)生出版社，2006，12．.
- 6. Chu EK，Whitenhead T，Shtsky AS．Effects of cyclic openm’g and closing at low-and high-volume ventilation on bronehoalveolar lavage cytokines．Crit Care Med，2004，32：168-174．.
- 7. Beale RJ，Bryg DJ，Bihari DJ．Immunonutrition in the critically ill：a systematic review of clinical outcome．Care Med，1999，27：2799-2805．.
- 8. Hayashi Y，Sawa Y，F(xiàn)ukuyama N，et al．Preoperative glutamine administration induces heat-shock protein 70 expression and attenuates cardiopulmonary bypass-induced inflammatory response by regulating nutric oxide synthase activity．Circulation，2002，106：2601-2607．.
- 9. Macdonald J，Galley HF，Webster NR．Oxidative stress and gene expression in sepsis．Br J Anaesth，2003，90：221-232．.
- 10. Alexander JW．Immunonutrition： the role of omega-3 fatty acids．Nutrition，1998，14：627-633．.