Experimental Study On The Therapeutic Efficacy Of Cluster Therapy In Blast-induced Acute Lung Injury

Objectives To explore the clinical significance of cluster therapy in early lung blast injury by observing the effects of cluster therapy combined with anisodamine,dexamethasone and ambroxol on arterial blood gas,inflammatory cytokine(IL-6)TNF-? and pulmonary pathological changes in the early(<48 h)primary blast lung injury model in rats.Methods Eighty Wistar rats were randomly divided into control group C(n = 5),injury group B(n = 15),ambroxol treatment group A(n = 15)and dexamethasone treatment group D,Scopolamine treatment group E(n = 15),combination of ambroxol,dexamethasone and anisodamine group F(15 rats).Each group except group C was divided into three subgroups(5 rats in each group)because of the sampling time of 6 hours and 24 hours and 48 hours.Only the thorax was exploded by using the three-way reducer pipe and the constant pressure aerodynamic simulation blasting device to make a model of lung blast injury in rats.The treatment group were injected intraperitoneally with Ambroxol 46.7mg / kg(three times a day)or(And)dexamethasone at a dose of 3.33 mg / kg(three times a day)at 5 mg / kg / d or(and)anisodamine.Rats in the injury group were injected intraperitoneally with an equal volume of normal saline.Respiratory rate and weight change were observed before and after injury.Five rats were sacrificed at 6 hours,24 hours and 48 hours after injury in each experimental group.Arterial blood gas analysis,Yelverton pathological score,lung tissue Wet / dry weight ratio(W / D),serum tumor necrosis factor-?(TNF-?)and interleukin-6(IL-6)were measured.The lung histopathology was observed.SPSS23.0 statistical software was used for statistical analysis.Results 1.Arterial blood gas analysis: After 24 hours of lung blast injury,progressive respiratory acidosis was found in the injury group.The difference was statistically significant in 48 hours after injury than that in the normal group(P < 0.05),and there was hypoxemia in the injury group.After treatment,blood gas analysis was more or less improved than that in the injured group(P < 0.05),especially in the cluster treatment group.There was no significant difference between the blood gas indexes and the normal group(p > 0.05).2.The levels of TNF-? and IL-6 in arterial blood: Plasma TNF-? reached the highest value at 24 hours after lung blast injury,and plasma IL-6 reached the highest value at 6 hours after lung blast injury(p < 0.05).After 24 hours of modeling,the mean value of TNF-? in each treatment group except ambroxol treatment group was lower than that in group B.The concentration of serum IL-6 in ambroxol group and dexamethasone group was significantly lower than that in group B after 6 hours(p < 0.05).3.The W / D value of lung tissue: The W / D value of lung tissue in group B was higher than that in group C(p < 0.05).The W / D value of lung tissue in group B was higher than that in group C(P < 0.05),but it was lower than that in group B.Compared with group B,the decrease of W / D in group F was more obvious.Compared with group B,the W / D value of lung tissue in group F decreased more significantly(p < 0.05)after 24 hours and 48 hours of treatment.The W / D values in F group were significantly lower than those in D and E groups after 48 hours(P = 0.050 and 0.019,respectively).4.Pathological changes of lung tissue: Except for group C,diffuse patchy hemorrhage was observed on the surface of lung tissue in all rats,volume of lungs increased,swelling,and the dark red foam were overflow at the lung section and tracheal cavity,the most obvious were at 6h and 24 h after injury,bilateral lung swelling alleviated 48 hours after blast injury.Under light microscopy,except for group C,alveolar epithelial cells and alveolar capillary damage were seen alveolar fusion formation of "bullae" alveolar and interstitial hemorrhage,edema,inflammatory cell infiltration,inflammation and edema were most obvious at 24 hafter blast detonation.Edema was relieved at 48 h after blast detonation.Those changes significantly relieved in the A,D,E and F group,and the lung injury changes of F group was the lightest.Conclusions 1.Using the constant pressure pneumatic simulation device and the tee pipe model,the model of the blast lung injury can be successfully made.2.After intraperitoneal injection of dexamethasone,anisodamine and ambroxol after lung blast injury,blood gas analysis was improved,inflammatory factor level was decreased and lung injury was alleviated,indicating that the three drugs could treat blast lung injury in rats,and there is an additive effect.The cluster therapy is superior to the single drug therapy.