Lung and Systemic Inflammation in Preterm Lambs on Continuous Positive Airway Pressure or Conventional Ventilation
Lung and Systemic Inflammation in Preterm Lambs on Continuous Positive Airway Pressure or Conventional Ventilation
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DOI：
10.1203/pdr.0b013e318189487e
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发表时间：
2009-01-01
影响因子：
3.6
通讯作者：
Pillow, J. Jane
中科院分区：
文献类型：
--
作者：
Polglase, Graeme R.;Hillman, Noah H.;Pillow, J. Jane
气管内脂多糖（LPS）引起急性炎症，损伤性机械通气导致肺部和全身炎症。我们的目的是确定在早产儿肺中，与常规机械通气（CMV）相比，持续气道正压通气（CPAP）是否能预防气管内LPS后的肺部和全身炎症。早产胎儿在133天胎龄（足月= 150天）分娩前36小时暴露于母体倍他米松和Epostane。羔羊插管并随机接受温和CMV（潮气量8 mL/kg）或8 cm H2O压力的CPAP。表面活性剂（10 mg/kg）与1 mg LPS或生理盐水混合，于15 min灌注气管。记录血气状态、通气变量和动脉压3小时。死后评估静态压力-容积曲线以及肺部和全身炎症。与CMV羔羊相比，CPAP羔羊的Paco(2)和分钟通气升高。与未通气的对照组相比，CPAP和CMV羔羊肺和肝脏中的细胞因子mRNA升高。气管内LPS增加了肺和肝脏中IL-1 β、IL-6和IL-8的细胞因子mRNA反应。CPAP组和CMV组在LPS治疗后，血液中性粒细胞下降相似。在早产羔羊中，CPAP对肺损伤的细胞因子标志物或对气管内LPS的全身反应没有降低。（儿科研究65:67-71,2009）
Intratracheal lipopolysaccharide (LPS) causes acute inflammation and injurious mechanical ventilation results in pulmonary and systemic inflammation. We aimed to determine in preterm lungs if continuous positive airway pressure (CPAP) protects against pulmonary and systemic inflammation, compared with conventional mechanical ventilation (CMV) after intratracheal LPS. Preterm fetuses were exposed to maternal betamethasone and Epostane 36 h before delivery at 133 d gestational age (term = 150 d). Lambs were intubated and randomized to receive gentle CMV (tidal volume 8 mL/kg) or CPAP with 8 cm H2O pressure. Surfactant (10 mg/kg) mixed with 1 mg LPS or saline was instilled into the trachea at 15 min. Blood gas status, ventilation variables, and arterial pressures were recorded for 3 h. Static pressure-volume curves and lung and systemic inflammation were assessed postmortem. CPAP lambs had elevated Paco(2) and minute ventilation compared with the CMV lambs. Cytokine mRNA was increased in the lungs and liver of CPAP and CMV lambs relative to unventilated controls. Intratracheal LPS amplified the cytokine mRNA responses of IL-1 beta, IL-6, and IL-8 in the lung and liver. Blood neutrophils decreased similarly after LPS in CPAP and CMV groups. Cytokine markers of lung injury or the systemic response to intratracheal LPS were not decreased by CPAP relative to CMV, in preterm lambs. (Pediatr Res 65: 67-71, 2009)