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目的观察通过电刺激迷走神经研究胆碱能抗炎通路对感染性休克大鼠急性肺损伤的保护作用。方法成年雄性SD大鼠40只,随机分为4组:假CLP组(SHAM)、CLP组(CLP)、迷走神经切断组(VGX)、迷走神经电刺激组(STM),每组10只,均采用盲肠结扎穿孔法(CLP)复制感染性休克模型,VGX组CLP后行双侧颈部迷走神经离断术,STM组在CLP基础上将左迷走神经远端连接刺激电极,于CLP术毕即刻予以持续电刺激(5 V、2 ms和1 Hz)20 min。动物均连续监测平均动脉压(MAP),分别在各组模型制备完毕或电刺激后0、1、2和4 h检测血浆肿瘤坏死因子(TNF)-α含量、4 h抽动脉血行血气分析计算呼吸指数和取肺组织观察肺组织病理学变化。结果CLP组和VGX组MAP进行性下降,STM组血压各时间点均显著高于CLP组相应值。STM组血浆TNFα含量显著低于CLP组和VGX组。4 h CLP组和VGX组pH值、PaO_2、PaCO_2和PaO_2/FiO_2显著下降(P<0.01),明显低于假CLP组和STM组(P<0.05)。光镜下CLP组和VGX组肺组织损害明显重于STM组和SHAM组。结论电刺激迷走神经通过胆碱能抗炎通路能逆转CLP致感染性休克大鼠血压下降,降低血清TNFα水平,减轻急性肺损伤所致低氧血症和肺水肿,减轻肺组织病理损害,对肺脏有保护作用。
Objective To investigate the protective effect of cholinergic anti-inflammatory pathway on acute lung injury in septic shock rats by electrically stimulating the vagus nerve. Methods Forty adult male Sprague-Dawley rats were randomly divided into 4 groups: sham-CLP group (CLP), VGX group, vagus nerve stimulation group (STM) The model of septic shock was replicated by cecal ligation and puncture (CLP). Bilateral cervical vagotomy was performed after CLP in VGX group. The STM group was established by CLP. The left vagal nerve was connected to the stimulation electrode at the distal end of CLP, Stimulation (5 V, 2 ms and 1 Hz) for 20 min. The animals were continuously monitored for mean arterial pressure (MAP). Plasma TNF-α levels were measured at 0, 1, 2, and 4 h after model preparation or after electrical stimulation, respectively. Respiratory index and lung tissue were taken to observe the pathological changes of lung tissue. Results The MAP of CLP group and VGX group decreased progressively, and the blood pressure of STM group was significantly higher than that of CLP group at each time point. The level of plasma TNFα in STM group was significantly lower than that in CLP group and VGX group. PH value, PaO_2, PaCO_2 and PaO_2 / FiO_2 significantly decreased in CLP group and VGX group (P <0.01) at 4 h, which were significantly lower than those in sham CLP group and STM group (P <0.05). The damage of lung tissue in CLP group and VGX group was significantly higher than that in STM group and SHAM group. Conclusion Electrical stimulation of the vagus nerve via the cholinergic anti-inflammatory pathway can reverse the blood pressure drop induced by CLP in septic shock rats, reduce the level of serum TNFα, reduce the hypoxemia and pulmonary edema induced by acute lung injury, alleviate the pathological damage of lung tissue, Have a protective effect.