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【目的】观察比例辅助通气(proportional assist ventilation,PAV)对胎粪吸入新生兔肺组织中基质金属蛋白酶2(MMP-2)、基质金属蛋白酶9(MMP-9)含量的影响。【方法】将30只日龄20～30d的幼兔随机分为灌入胎粪后实施比例辅助通气组(PAV组),灌入胎粪后实施同步间歇指令通气组(SIMV组),并与胎粪吸入不予通气组及灌生理盐水组进行对照,各组分别于8h后处死,ELISA法检测肺组织匀浆及肺泡灌洗液中MMP-2、MMP-9的水平。【结果】不同组之间肺组织匀浆中MMP-2(F=72.575,P=0.000)和MMP-9数值(F=48.374,P=0.000)的差异有统计学意义;各组之间肺组织匀浆中MMP-2和MMP-9数值差异均有统计学意义(P<0.05),以SIMV组最高,生理盐水对照组最低;不同组之间肺泡灌洗液中MMP-2(F=116.779,P=0.000)和MMP-9数值(F=59.095,P=0.000)的差异有统计学意义(F=48.734,P=0.000);各组之间肺泡灌洗液中MMP-9数值差异均有统计学意义(P<0.05),以SIMV组最高,生理盐水对照组最低。PAV组和SIMV组在通气后2h(F=46.095,P=0.000)、4h(F=50.757,P=0.000)、6h(F=56.127,P=0.000)和8h(F=73.684,P=0.000)的气道峰压(PIP)数值差异均有统计学意义,PAV组显著低于SIMV组。【结论】在维持正常经皮氧饱和度和血气情况下,PAV模式下肺组织匀浆及肺泡灌洗液中MMP-2,MMP-9含量及PIP较SIMV模式下低,所致肺损伤程度较SIMV模式小,提示当机械通气治疗MAS时,优先考虑使用PAV模式。
【Objective】 To investigate the effects of proportional assist ventilation (PAV) on the expression of matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9) in lungs of meconium-naive rabbits. 【Methods】 Thirty young rabbits aged 20-30 days were randomly divided into PAV group and meconium-supplemented ventilation group (SIMV group) after meconium infusion. The rats in each group were sacrificed after 8h, and the levels of MMP-2 and MMP-9 in lung homogenate and BALF were detected by ELISA. 【Results】 The results showed that the difference of MMP-2 (F = 72.575, P = 0.000) and MMP-9 (F = 48.374, P = 0.000) in lung homogenate between different groups was statistically significant; The difference of MMP-2 and MMP-9 in the tissue homogenate was statistically significant (P <0.05), the highest in SIMV group and the lowest in normal saline control group. The expression of MMP-2 in bronchoalveolar lavage fluid (F = (F = 48.734, P = 0.000). The difference of MMP-9 in bronchoalveolar lavage fluid between groups was statistically significant (F = 48.734, P = 0.000) (P <0.05), the highest in SIMV group and the lowest in saline control group. The PAV group and the SIMV group were significantly better at 2 h after ventilation (F = 46.095, P = 0.000), 4h (F = 50.757, P = 0.000), 6h (F = 56.127, P = 0.000) and 8h ) Peak airway pressure (PIP) values were statistically significant differences, PAV group was significantly lower than the SIMV group. 【Conclusion】 The levels of MMP-2 and MMP-9 in lung homogenate and BALF in PAV model and PIP are lower than those in SIMV mode under the condition of maintaining normal percutaneous oxygen saturation and blood gas, and the degree of lung injury Smaller than SIMV mode, suggesting that PAV mode is preferred when mechanical ventilation is used to treat MAS.