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目的制备大鼠急性一氧化碳中毒(ACOP)模型,观察肺损伤的病理学与病理生理学变化,比较氧合指数和碳氧血红蛋白(HbCO)与急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的相关性。方法健康Wistar大鼠静式吸入一氧化碳(CO)1h建立ACOP模型,对照组20只,中毒组按吸入CO浓度分为轻(A组)、中(B组)、重(C组)三组,每组20只。染毒后,分别检测各组动脉血气分析、HbCO浓度。取肺组织切片,观察病理学改变,根据检查结果进行统计学分析。结果B组和C组CO中毒的ALI/ARDS发生率分别为25%和55%,均明显高于对照组(P<0.05,P<0.01);A、B、C组的动脉血HbCO均明显高于对照组(P<0.01),而动脉血PaO_2均明显低于对照组(P<0.01)。ALI/ARDS组的动脉血HbCO(62.4±19.1)%明显高于非ALI/ARDS组(29.9±13.8)%(P<0.01);ALI/ARDS组的动脉血PaO_2(51.3±13.1)明显低于非ALI/ARDS组(79.0±15.8)(P<0.01);ALI/ARDS组的动脉血A-aDO_2(37.6±27.9)mmHg亦高于非ALI/ARDS组(24.2±15.7)mmHg(P<0.05);而ALI/ARDS组的动脉血PaCO_2(43.5±15.4)与非ALI/ARDS组(41.0±6.4)比较,差异无统计学意义(P<0.05)。HbCO与氧合指数(本文与动脉氧分压PaO_2表示)两指标诊断ALI/ARDS差异有统计学意义(P<0.05)。根据本实验数据制定诊断截断值,即:ACOP患者动脉血HbCO>43%即可认为有ALI/ARDS的发生。结论ACOP可导致ALI/ARDS的发生与低张性缺氧;与氧合指数比较,HbCO浓度诊断ALI/ARDS更灵敏。
OBJECTIVE: To establish a rat model of acute carbon monoxide poisoning (ACOP) and observe the pathological and pathophysiological changes of lung injury. To compare the changes of oxygenation index (Hbco) and acute lung injury / acute respiratory distress syndrome (ALI / ARDS) Correlation. Methods The ACOP model was established by inhalation of carbon monoxide (CO) in healthy Wistar rats for 1 hour. Twenty control rats were divided into three groups: light (group A), medium (group B), and heavy (group C) Each group of 20. After exposure, the arterial blood gas analysis and the concentration of HbCO were detected in each group. Take lung tissue sections, observe the pathological changes, according to the test results for statistical analysis. Results The ALI / ARDS rates of CO poisoning in group B and group C were 25% and 55%, respectively, which were significantly higher than those in control group (P <0.05, P <0.01). The arterial blood HbCO in groups A, B and C were all significantly (P <0.01), while the PaO 2 in arterial blood was significantly lower than that in the control group (P <0.01). Arterial blood HbCO (62.4 ± 19.1)% in ALI / ARDS group was significantly higher than that in non-ALI / ARDS group (29.9 ± 13.8)% (P <0.01) In the ALI / ARDS group, the arterial A-aDO_2 (37.6 ± 27.9) mmHg in ALI / ARDS group was also significantly higher than that in the non-ALI / ARDS group (79.0 ± 15.8, P <0.01) ). There was no significant difference in PaCO_2 (43.5 ± 15.4) and ALI / ARDS (41.0 ± 6.4) between ALI and ARDS groups (P <0.05). HbCO and oxygenation index (in this paper and arterial oxygen pressure PaO_2 said) two indicators of ALI / ARDS difference was statistically significant (P <0.05). According to the experimental data to develop diagnostic cutoff value, namely: ACOP patients arterial blood HbCO> 43% can be considered ALI / ARDS. Conclusion ACOP can cause the occurrence of ALI / ARDS and hypoxia. Compared with oxygenation index, HbCO concentration is more sensitive to diagnose ALI / ARDS.