Ligustrazine Injection Treatment Of Pulmonary Contusion Clinical And Experimental Research

Objective:To observe the influences of TMP injection on plasma ET-1 level,arterial oxygen tension(PaO₂),the partial pressure of carbon dioxide(PaCO₂),the oxygenation index (PaO₂/FiO₂)in patients with pulmonary contusion and ET-1 concentration in lung reperfusion injury rabbits' bronchoalveolar lavage fluid(BALF),ratio of neutrophil, lung permeability index,plasma concentration ofET-1,PaO₂,lung wet/dry ratio of lung tissue pathology,and other related indicators in rabbits with pulmonary contusion.On the other side,we will search the mechanism of TMP on treating and preventing further acute lung injury(ALI).Methods:We adopt two kinds of different research methods,animal experiment and clinical observation.1.Clinic research:60 patients with pulmonary contusion who were examined in Emergency Department and Cardiothoracic Surgery Ward at the first hospital of Wuhan became research objects from 2005.09 to 2007.12.The patients were randomly divided into treatment group and control group,two groups of similar severity of the injury.Control group was gave conventional treatment,such as giving oxygen,anti-infection,easing bronchial spasms and other treatment since in hospital; if was seriously ill,we tryed to add plus hormones,rib fractures were partially fixed; with hemopneumothorax,according to the specific circumstances gave chest puncture exhaust or closed drainage.The treatment group was on the basis of conventional therapy and added TMP injection,120 mg per day,once a week for treatment.In this period we observed the clinical symptomatic and clinical curative effect,we also examined plasma ET-1 level,blood PaO₂,PaCO₂,PaO₂/FiO₂,chest radiography and other indicators before and after treatment. 2.Animal-experiment study:1)Experiment 1:Choosing 40 health New Zealand rabbits,we made them into five groups randomly:health group,model group,TMP group,Chinese medicine and western medicine groups.There were 8 rabbits in every group.Referring to Chen yongbing's method,we used weights freefall impact injury to cause rabbit pulmonary contusion model,injected administration from ear edge vein at 0h,8h and 16h after injury.And we measured arterial blood gas and plasma concentration of ET-1 at 24h after injury,and then killed the animals.Four from each organization underwent lung biopsy and pathological and tested lung wet/dry weight ratio;the other half lung specimens were lavaged and tested bronchoalveolar lavage fluid and plasma protein content of lung permeability index(lung permeability index,LPI)(BALF protein content/plasma protein content)with Lowry determination.We made cell count with microscope,calculated the proportion of neutrophil and detected the ET-1 level of fluid.2)Experiment 2:Choosing 24 health New Zealand rabbits,we made them into three groups randomly:health group,model group,TMP group.There were 8 rabbits in every group.Referring to Chen yongbing's method,we used weights freefall impact injury to cause rabbit pulmonary contusion model,injected administration from ear edge vein immediately after injury.And we detected arterial blood gas,plasma level of ET-1 concentration at 2h,4h,8h,12h and 24h after injury,then killed the animals. After that,the remaining process was similar with the experiment one.All measurement data was used mean±standard deviation((?)±s).We analyzed data by t-test,compared curative effect by Ridit analyse,and compared rate by X²-test, P＜0.05 for statistical significance,P＜0.01 for a very significant difference.Results:1.Clinic obverse study result:the treatment group was superior to the control group; there had not remarkable difference between two groups in pulmonary contusion score and the type of TCM before treatment,P＞0.05.But there are obvious difference in the examination of plasma ET-1 level,blood PaO₂ and PaCO₂.After the treatment, the level of plasma ET-1 decreased significantly,blood PaO₂ and PaCO₂ improved, PaO₂/FiO₂ increased;showing in the chest radiography,the injury site's congestion, effusion and other symptoms disappeared and absorbed fasterly,compared to the control group,P＜0.05.2.The result of experiment research:the study results showed that,TMP could decrease the lung wet/dry weight ratio,BALF and plasma concentration of ET-1, neutrophil proportion of lung permeability index,lung disease pathology seized score significantly and increase the blood PaO₂ markedly.Compared with the model group, P＜0.05,which is significant difference.Conclusion:1.TMP has significantly ET-1 antagonist and can reduce its level,which was significantly increasing in the plasma and BALF after pulmonary contusion;2.TMP is on the treatment of pulmonary contusion,which may be through improving the microcirculation after the pulmonary contusion,reducing the level of ET-1 and increasing antagonist of ET-1's vasoconstrictor effect,so as to reduce the secondary lung injury which caused by the ET-1,and promote injury repair and the restoration of pulmonary function.