Adrenaline aggravates lung injury caused by liver ischemia-reperfusion and high-tidal-volume ventilation in rats.
Adrenaline aggravates lung injury caused by liver ischemia-reperfusion and high-tidal-volume ventilation in rats.
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DOI：
10.1186/s40560-016-0130-y
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发表时间：
2016
影响因子：
7.1
通讯作者：
Kurahashi K
中科院分区：
文献类型：
--
作者：
Ota S;Yazawa T;Tojo K;Baba Y;Uchiyama M;Goto T;Kurahashi K
我们经常给予肾上腺素，以改善患有全身性炎症的患者的低血压，而这些患者没有接受容量复苏治疗。休克状态下肾上腺素对受损肺的影响尚未阐明。我们先前证实，在大鼠中，高潮气量通气后的肝脏缺血再灌注可诱导全身炎症、低血压和肺损伤。利用该动物模型，我们研究了肾上腺素对肺损伤和血流动力学的影响。麻醉大鼠进行通气，并进行两次肝流入中断15 min。第二次肝缺血再灌注后，潮气量由6 ml·kg-1增加至24 ml·kg-1体重，再灌注后观察360 min，观察组和对照组各12只。根据动脉血压的下降给予额外的液体。肾上腺素给药显著减少了静脉复苏液的体积。肺的湿重/干重比值较高（7.53 ± 0.37vs.4.63 ± 0.35，P <0.001），动脉血氧分压降低（213 ± 48 vs. 411 ± 33，P = 0.004），支气管肺泡灌洗液中肿瘤坏死因子-α浓度（102.64 ± 100.22）高于肾上腺素组（101.91 ± 100.27）（P = 0.015）。组织学检查显示接受肾上腺素的大鼠肺泡腔中有明显渗出。连续给予肾上腺素部分防止了高潮气量通气的肝脏缺血再灌注大鼠模型中血压的快速下降，但恶化了肺损伤。肾上腺素给药可能会加重呼吸机引起的肺损伤，在全身性炎症应予以考虑。
We often administer adrenaline to improve hypotension of patients undergoing systemic inflammation that is not treated with volume resuscitation. The effects of adrenaline on injured lungs during shock status have not been elucidated. We previously demonstrated that hepatic ischemia–reperfusion followed by high-tidal-volume ventilation-induced systemic inflammation, hypotension, and lung injury in rats. Using this animal model, we investigated the effects of adrenaline on lung injury and hemodynamics. Anesthetized rats were ventilated and underwent hepatic inflow interruption for 15 min twice. After the second liver ischemia–reperfusion, the tidal volume was increased to 24 ml · kg−1 body weight from 6 ml · kg−1, and 12 rats in each group were observed for 360 min after reperfusion with or without continuous intravenous adrenaline administration. Extra fluid was administered according to the decline in the arterial blood pressure. Adrenaline administration significantly reduced the volume of intravenous resuscitation fluid. The wet-to-dry weight ratio of the lungs was higher (7.53 ± 0.37 vs. 4.63 ± 0.35, P < 0.001), the partial oxygen pressure in arterial blood was lower (213 ± 48 vs. 411 ± 33, P = 0.004), and the tumor necrosis factor-α concentration in bronchoalveolar lavage (BAL) fluid was higher (102.64 ± 100.22 vs. 101.91 ± 100.27, P = 0.015), with adrenaline. Histopathological examinations revealed marked exudation in the alveolar spaces in rats receiving adrenaline. Continuous administration of adrenaline partially prevented a rapid decline in blood pressure but deteriorated lung injury in a rat model of liver ischemia–reperfusion with high-tidal-volume ventilation. A possibility that adrenaline administration aggravate ventilator-induced lung injury during systemic inflammation should be considered.