CAJ | 학술논문

目的观察常温肝素液对猪自体肺叶移植术后肺组织超微结构及气体交换能力变化的影响.方法将杂种猪18只随机分为对照组、肝素组及Euro-Collins(EC)液组.各组均在全肺切除后立即行自体肺叶移植(左侧全肺切除+左肺下叶白体肺叶移植),对照组予常温生理盐水,肝素组予常温肝素液灌注供肺,EC液组予4℃ EC液灌注.移植前、移植后0.5、1、2、4h检测移植肺的肺静脉血氧分压(PvO2)、二氧化碳分压(PvCO2)、肺动态顺应性(Cdyn),移植肺组织中的氧自由基髓过氧化物酶(MPO)活性,移植肺组织的湿干重比(W/D)及电镜结构变化.结果与对照组比较,肝素组及EC液组移植后4h的PvO2、PvCO2、Cdyn,W/D及电镜结构差异有统计学意义(P<0.05),肝素组与EC液组间差异无统计学意义(P>0.05).结论无论是常温肝素液还是低温EC液,对供肺叶的灌注均能较好地保持移植肺的结构,保护移植肺的气体交换功能.常温肝素灌注后的供肺叶能满足自体肺叶移植的要求.
목적 관찰상온간소액대저자체폐협이식술후폐조직초미결구급기체교환능력변화적영향.방법 장잡충저18지수궤분위대조조、간소조급Euro-Collins(EC)액조.각조균재전폐절제후립즉행자체폐협이식(좌측전폐절제+좌폐하협백체폐협이식),대조조여상온생리염수,간소조여상온간소액관주공폐,EC액조여4℃ EC액관주.이식전、이식후0.5、1、2、4h검측이식폐적폐정맥혈양분압(PvO2)、이양화탄분압(PvCO2)、폐동태순응성(Cdyn),이식폐조직중적양자유기수과양화물매(MPO)활성,이식폐조직적습간중비(W/D)급전경결구변화.결과 여대조조비교,간소조급EC액조이식후4h적PvO2、PvCO2、Cdyn,W/D급전경결구차이유통계학의의(P<0.05),간소조여EC액조간차이무통계학의의(P>0.05).결론 무론시상온간소액환시저온EC액,대공폐협적관주균능교호지보지이식폐적결구,보호이식폐적기체교환공능.상온간소관주후적공폐협능만족자체폐협이식적요구.
Objective To observe the effects of normothermic heparin pulmonary artery infusion on pulmonary function and ultra-structures in the swine model of left single lung auto-transplantation. Methods Eighteen healthy local pigs were used as experimental animals, received left pneumonectomy and lobar lung auto-transplantation (left lower lobe) , and divided into three groups randomly (n=6 in each group) according to different pulmonary artery perfusion protocols (control group with normothermic saline, normothermic heparin group with heparin in normal temperature, and cold EC group with 4 X. Euro-Collins). The blood samples and lung tissues were collected at baseline, 0. 5 , 1,2, and 4 h after lobar lung auto-transplantation respectively. The indices were determined as follows: PvO2, PvCO2, dynamic lung compliance (Cdyn), and myeloperoxidase(MPO) content in the transplanted lung tissues. The lung tissue wet/dry ratio (W/D) was analyzed. At 4 h after lung (or lobar lung) auto-transplantation, the pulmonary grafts were sampled for ultra-structure observation under the electronic microscopy. Results Compared to control group at the 4th h post-operation, PvO2, PvCO2, Cydn, MPO and W/D levels and ultra-structures had significant difference in normothermic heparin group and cold EC group (P<0.05), but there was no difference between normothermic heparin group and cold EC group. Conclusion Pulmonary artery perfusion with normothermic heparin or cold Euro-Collins solution can preserve the transplanted lobar lung structure, reduce the ischemia-reperfusion injury, and maintain the gas exchange function. Pulmonary artery infusion with normothermic heparin meets the requirement of lobar lung auto-transplantation.