中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2012年
12期
2522-2524
,共3页
龙小毛%林辉%李香伟%周一凡%梁胜景
龍小毛%林輝%李香偉%週一凡%樑勝景
룡소모%림휘%리향위%주일범%량성경
肺移植%肺保存%肺损伤%体外灌注
肺移植%肺保存%肺損傷%體外灌註
폐이식%폐보존%폐손상%체외관주
Lung transplantation%Lung preservation%Lung injury%Ex vivo perfusion
目的 观察体外温血持续灌注对供体肺的保护作用.方法 将低钾右旋糖酐液(LPD)经肺动静脉灌注后的供肺,分别4℃低温保存6h(Ⅰ组,n=8)与经肺动脉温血灌注6h保存(Ⅱ组,n=8)后进行猪左肺移植,检测术后24h肺通气阻力(LR)、动脉左下肺血氧分压(PaO2)、肺含水量等肺功能指标,并用光镜观察肺组织损伤、荧光显微镜观察闭锁小带-l(ZO-1)的分布特点.结果 肺功能检测:Ⅱ组术后LR水平为7.1～17.9 cm H2O/L(1 cm H2O =0.098 kPa),肺含水量为78％ ～85％;Ⅰ组术后LR水平为13.6 ～46.5 cm H2O/L,肺含水量为86％ ～ 94％;相同时间点Ⅱ组LR及肺含水量显著低于Ⅰ组(P＜0.05);Ⅰ组术后PaO2水平为66.5 ～ 113.2 mm Hg(1 mmHg=0.133 kPa),Ⅱ组术后PaO2水平为93.9 ～ 116.1 mm Hg,Ⅰ组术后6、12、24 h时间点PaO2显著低于Ⅱ组(P＜0.05).肺损伤组织学评估:Ⅰ组保存后6h仅见极少量抗ZO-1抗体染色,移植后24h未见明显修复;Ⅱ组保存后6h见较多抗ZO-1抗体染色,移植后24h已见连接部分修复.光镜观察Ⅱ组50％ ～60％肺组织肺泡腔内有水肿液及炎性细胞渗出;Ⅰ组肺组织病变显著,80％ ～ 90％肺组织肺泡腔内有明显水肿液及炎性细胞渗出,肺泡腔内见红细胞外渗,肺泡上皮细胞结构不清.结论 体外温血持续灌注是一种更好的供肺保肺技术,可减轻低温保存供肺所致的时间依赖性缺血再灌注肺损伤,并可促进肺组织的自我修复.
目的 觀察體外溫血持續灌註對供體肺的保護作用.方法 將低鉀右鏇糖酐液(LPD)經肺動靜脈灌註後的供肺,分彆4℃低溫保存6h(Ⅰ組,n=8)與經肺動脈溫血灌註6h保存(Ⅱ組,n=8)後進行豬左肺移植,檢測術後24h肺通氣阻力(LR)、動脈左下肺血氧分壓(PaO2)、肺含水量等肺功能指標,併用光鏡觀察肺組織損傷、熒光顯微鏡觀察閉鎖小帶-l(ZO-1)的分佈特點.結果 肺功能檢測:Ⅱ組術後LR水平為7.1～17.9 cm H2O/L(1 cm H2O =0.098 kPa),肺含水量為78％ ～85％;Ⅰ組術後LR水平為13.6 ～46.5 cm H2O/L,肺含水量為86％ ～ 94％;相同時間點Ⅱ組LR及肺含水量顯著低于Ⅰ組(P＜0.05);Ⅰ組術後PaO2水平為66.5 ～ 113.2 mm Hg(1 mmHg=0.133 kPa),Ⅱ組術後PaO2水平為93.9 ～ 116.1 mm Hg,Ⅰ組術後6、12、24 h時間點PaO2顯著低于Ⅱ組(P＜0.05).肺損傷組織學評估:Ⅰ組保存後6h僅見極少量抗ZO-1抗體染色,移植後24h未見明顯脩複;Ⅱ組保存後6h見較多抗ZO-1抗體染色,移植後24h已見連接部分脩複.光鏡觀察Ⅱ組50％ ～60％肺組織肺泡腔內有水腫液及炎性細胞滲齣;Ⅰ組肺組織病變顯著,80％ ～ 90％肺組織肺泡腔內有明顯水腫液及炎性細胞滲齣,肺泡腔內見紅細胞外滲,肺泡上皮細胞結構不清.結論 體外溫血持續灌註是一種更好的供肺保肺技術,可減輕低溫保存供肺所緻的時間依賴性缺血再灌註肺損傷,併可促進肺組織的自我脩複.
목적 관찰체외온혈지속관주대공체폐적보호작용.방법 장저갑우선당항액(LPD)경폐동정맥관주후적공폐,분별4℃저온보존6h(Ⅰ조,n=8)여경폐동맥온혈관주6h보존(Ⅱ조,n=8)후진행저좌폐이식,검측술후24h폐통기조력(LR)、동맥좌하폐혈양분압(PaO2)、폐함수량등폐공능지표,병용광경관찰폐조직손상、형광현미경관찰폐쇄소대-l(ZO-1)적분포특점.결과 폐공능검측:Ⅱ조술후LR수평위7.1～17.9 cm H2O/L(1 cm H2O =0.098 kPa),폐함수량위78％ ～85％;Ⅰ조술후LR수평위13.6 ～46.5 cm H2O/L,폐함수량위86％ ～ 94％;상동시간점Ⅱ조LR급폐함수량현저저우Ⅰ조(P＜0.05);Ⅰ조술후PaO2수평위66.5 ～ 113.2 mm Hg(1 mmHg=0.133 kPa),Ⅱ조술후PaO2수평위93.9 ～ 116.1 mm Hg,Ⅰ조술후6、12、24 h시간점PaO2현저저우Ⅱ조(P＜0.05).폐손상조직학평고:Ⅰ조보존후6h부견겁소량항ZO-1항체염색,이식후24h미견명현수복;Ⅱ조보존후6h견교다항ZO-1항체염색,이식후24h이견련접부분수복.광경관찰Ⅱ조50％ ～60％폐조직폐포강내유수종액급염성세포삼출;Ⅰ조폐조직병변현저,80％ ～ 90％폐조직폐포강내유명현수종액급염성세포삼출,폐포강내견홍세포외삼,폐포상피세포결구불청.결론 체외온혈지속관주시일충경호적공폐보폐기술,가감경저온보존공폐소치적시간의뢰성결혈재관주폐손상,병가촉진폐조직적자아수복.
Objective To study the protective effect of normothermic ex vivo perfusion on donorlung injury.Methods The donor lungs were flushed with LPD solution through the pulmonary artery and vein,and preserved with 4℃ cold static preservation (Ⅰ group,n =8) and normothermic ex vivo perfusion (Ⅱ group,n =8) for 6 h respectively.Then the left lung was transplanted and reperfused for 24 h,and lung function and lung injury were evaluated in both groups post-transplantation.Results After transplantation,the LR in Ⅱ group was 7.1-17.9 cm H2O/L (1 cm H2O =0.098 kPa),and wet-to-dry lung weight ratio was 78％-85％ ; The LR in Ⅰ group was 13.6-46.5 cm H2O/L,and wet-to-dry lung weight ratio was 86％-94％,The LR and wet-to-dry lung weight ratio in Ⅱ group were significantly lower than in Ⅰ group (P＜0.05).PaO2 in Ⅰ group and Ⅱ group was 66.5-113.2 mm Hg (1 mm Hg=0.133 kPa)and 93.9-116.1 mm Hg,respectively (P＜0.05).At the end of the preservation period (6 h) and after transplantation,weak ZO-1 immunoreactivity was seen in Ⅰ group,whereas the Ⅱ group showed many preserved ZO-1 membrane-associated plaques along the alveolar cells,furthermore more ZO-1 reactivity was seen at 24 h.Light microscopy revealed that 50％-60％ lung alveolus in Ⅱ group had edema fluid and inflammatory cell infiltration,and 80％-90％ lung alveolus in Ⅰ group had edema fluid and inflammatory cell infiltration.Conclusion Normothermic ex vivo perfusion is a better technique for lung preservation.It ameliorates hypothermic time-dependent ischemic injury and accelerates donor lung recovery.
