Effects Of Joint Hydroxyethyl Starch And Furosemide On Acute Lung Injury Induced By Paraquat In Pigs Under PICCO

Paraquat is a relatively non-selective foliage-applied contact herbicide, and is inactive when in contact with almost all naturally occurring soils. It is the most lethal pesticide for people and animals. Accidental or intentional ingestion of the high concentrated liquid herbicide is one of the most common Clinical cases,which has been responsible for many deaths. A lot of previous studies demonstrated that PQ poisoning is the most lethal pesticide in our country, with a mortality of nearly 50-70% when ingested by humans. However, the mechanism of paraquat poisoning is not yet fully understood and there is no effective antagonist treatment. Many scholars are devoted to this subject. As a result, the use of PQ causes more and more attention of international organizations and the environmental protection department, even rejected by medical scholars in developing countries.And the study of PQ’treatment is particularly important. Therefore, studying the mechanism and treatment of PQ poisoning is important.In recent years, the concept of pulmonary fibrosis cytokine network has been put forward. The basic pathological changes are acute inflammatory response and increase of pulmonary microvascular permeability. And the levels of inflammatory cytokines in the PQ poisoning may play a more important role in pulmonary fibrosis. The consequences are pulmonary inflammation and fibrosis, which is the main cause of death in patients surviving the early phase of paraquat poisoning. The expression of inflammatory cytokines may increase tissue damage, and severe PQ poisoning is characterized by multiple-organ failure, which mainly involves the lungs, kidneys, liver, heart and also the nervous system. The lung is a major target organ in paraquat poisoning, which can lead to ALI/ARDS. Lung concentrations are 10 to 90 times higher than in the bloodstream. Thus, lung injury is particularly severe with rapid progression after PQ poisoning. Rapid emergence of early pulmonary edema, pulmonary hemorrhage and atelectasis develops into irreversible pulmonary fibrosis, which is the primary cause of death. Recent studies have shown that 6% HES 130/0.4 can reduce the inflammatory response by reducing endothelial cell injury and activity, improving microcirculation. Previous studies demonstrated that HES can improve tissue oxygen by reducing the interstitial colloid osmotic pressure and endothelial cells edema.At present, the HES treatment of acute lung injury caused by PQ is still lack of experimental and clinical research. The object of my study is to explore the clinical effect of the combination therapy of hydroxyethyl starch with furosemide for the acute lung injury of pigs suffering from PQ, and provide theoretical basis for clinical treatment. ObjectiveTo discuss the effects of joint 6% hydroxyethyl starch 130/0.4 and furosemide on acute lung injury induced by paraquat(PQ) in pigs under Pulse indicates continuous cardiac output(Pi CCO)monitoring. MethodsThe first step is to establish models:The ALI/ARDS model was made by means of 18 healthy female piglets with an intraperitoneal injection of 20% PQ(20ml). And then the 18 pigs were randomly divided into three groups: voluven group(A), furosemide group(B) and voluven+furosemide group(C)(6 pigs in each group). Indexes among the three groups were carefully observed at time of before the model was made(baseline),time of the model was made(t0) and 2h(t2),4h(4),6h(t6)and 8h(t8) after trearment including:The changes of the heart rate(HR), mean arterial pressure(MAP), extravascular lung water index( ELWI),pulmonary vascular permeability index(PVPI) were measured by PICCO,the changes of partial pressure of carbon dioxide(Pa CO2) and oxygenation index(Pa O2/Fi O2) were measured by collecting arterial blood samples. Lung tissue of all animals were obtained by punctureneedle, and then stained by Hematoxylin and eosin(HE),and pulmonary pathology were observed under light microscopy. ResultsThe HR and MAP of all animals increased obviously while the oxygenation index declined and Pa CO2 increased evidently compared to time of baseline when the models were established(all P<0.05).At the same time, compared to C,the HR and MAP of A and B were significantly lower after treatment(all P<0.05),while the oxygenation index of A and B were significantly higher(all P>0.05). Compared to time of baseline when the models were established, the ELW and PVPI of all animals increased obviously(all P<0.05).The ELW and PVPI were decreased after treatment, and at the same time, the ELW and PVPI of A and B were significantly lower than that of C after treatment(all P<0.05). The alveolar tissue shows obviously traumatic change when the models were established. The damage was relieved 8h after trearment, which was most evident in group C. ConclusionWith the combination of 6% hydroxyethyl starch 130/0.4 and furosemide can effectively relieve the acute lung injury induced by paraquat poisoning, promote gas exchange, and improve oxygenation.