体外循环期间经肺动脉灌注肺保护液对犬肺形态及功能的保护作用

doi:吉林省科技厅科技发展计划项目资助课题（20

体外循环期间经肺动脉灌注肺保护液对犬肺形态及功能的保护作用

林柏松¹，李玉林²，张秀和¹，张柏民¹，姜亦忠¹

（1.吉林大学中日联谊医院心脏外科，吉林长春 130033； 2.吉林大学基础医学院病理生物学教育部重点实验室，吉林长春 130021）

收稿日期:2008-05-22 修回日期:1900-01-01 出版日期:2008-11-28 发布日期:2008-11-28

Protective effect of pulmonary artery perfusion with lung-protective solution on lung morphous and function of dogs during cardiopulmonary bypass

LIN Bai-song¹,LI Yu-lin²,ZHANG Xiu-he¹,ZHANG Bai-min¹,JIANG Yi-zhong¹

（1.Department of Cardiovascular Surgery,China-Japan Union Hospital,Jilin University,Changchun 130033,China; 2.Key Laboratory of Pathobiology,Ministry of Education,School of Basic Medical Sciences,Jilin University,Changchun 130021,China）

Received:2008-05-22 Revised:1900-01-01 Online:2008-11-28 Published:2008-11-28

摘要/Abstract

摘要： 目的：探讨体外循环期间经肺动脉灌注肺保护液及氧合机器血对犬肺形态及功能的保护效果。方法：将18只杂种犬随机分为对照组、氧合血组(B组)及保护液组(P组)（每组6只）。体外循环（CPB）期间氧合血组及保护液组分别经肺动脉灌注氧合机器血和肺保护液， CPB前及停止后15及60 min，监测气道峰压、肺血管阻力和肺静脉血氧分压，留取血标本做生化分析，对肺组织进行光、电镜观察。结果：氧合血组CPB后15和60 min气道阻力均明显高于CPB前（P<0.05），且低于对照组相应时间点（P<0.05）。各组CPB后15和60 min肺血管阻力均明显高于CPB前（P<0.01），肺保护液组CPB后15和60 min肺血管阻力明显低于氧合血组及对照组（P<0.05）。各组CPB后15和60 min氧指数均明显高于CPB前（P<0.01），肺保护液组CPB后15和60 min氧指数明显高于氧合血组及对照组（P<0.05）。肺保护液组CPB后60 min 肺泡-动脉氧压力差（P_［A-a］O₂）明显低于氧合血组及对照组（P<0.001）。肺保护液组肺组织MDA含量及支气管肺泡灌洗液（PAL）中性粒细胞计数明显低于氧合血组（P<0.05）及对照组（P<0.001，P<0.05），且氧合血组低于对照组（P<0.01， P<0.05）。肺保护液组组织学改变明显轻于氧合血组（P<0.05）及对照组（P<0.001），且氧合血组明显轻于对照组（P<0.001）。结论： CPB后肺脏形态和功能有明显变化，肺动脉灌注低温肺保护液对犬肺形态和功能有良好保护作用。

关键词: 肺保护, 体外循环

Abstract: To explore the protective effect of pulmonary artery perfusion with lung-protective solution and oxygenated blood on lung morphous and function of dogs during cardiopulmonary bypass (CPB).Methods Eighteen adult mongrel dogs were randomly divided into three groups.During CPB,the lungs of the dogs in first group were perfused with diluted oxygenated blood from CPB-machine(group B),the lungs of the dogs in second group were perfused with cold lung-protective solution (group P),the lungs of the dogs in third group were perfused with nothing (control group).Malondialdehyde (MDA) of lung tissue,alveolar-arterial oxygen gradient (P_［A-a］O₂),the ratio of white blood cells in BALf and lung function were measured at different time points （before CPB and 15 and 60 min after CPB）,lung biopsies were also made. Results The levels of airway resistance at the 15th and 60th minutes after CPB in group B were higher than before CPB (P<0.05). The levels of airway resistance at the 15th and 60th minutes after CPB in group B were lower than those in control group at the same time points (P<0.01).The levels of pulmonary vascular resistance at the 15th and 60th minutes after CPB in each group were lower than before CPB (P<0.01).The levels at the 15th and 60th minutes after CPB in group B and control group were higher than the levels at the same time points in group P(P<0.05).The levels of PaO₂/FiO₂ at the 15th and 60th minutes after CPB in each group were higher than before CPB (P<0.01).The levels of PaO₂/FiO₂ at the 15th and 60th minutes after CPB in group B and control group were lower than the levels at the same time points in group P(P<0.05).The level of P_［A-a］O₂ at the 60th minute after CPB in group P was lower than those in group B and control group (P<0.001).The level of MDA and neutrophil percentage in BALF at the 90th minute after CPB in group P were lower than those in group B(P<0.05) and control group (P<0.001,P<0.05),and the level s in B group were lower than those in control group (P<0.001,P<0.05).Morphological analysis revealed that the percentage of pathological lesion and alveolar hemorrhage grade values in group P were than those in group B(P<0.05) and control group (P<0.001),and they were lower in group B than control group (P<0.001) Conclusion The morphous and function damage occurs in lungs after CPB.Both oxygenated blood and lung-protective solution have protective effect on lung morphous and function.

Key words: cardiopulmonary bypass, lung injury

中图分类号:

R-332

林柏松，李玉林，张秀和，张柏民，姜亦忠. 体外循环期间经肺动脉灌注肺保护液对犬肺形态及功能的保护作用[J]. J4, 2008, 34(6): 975-979.

LIN Bai-song,LI Yu-lin,ZHANG Xiu-he,ZHANG Bai-min,JIANG Yi-zhong. Protective effect of pulmonary artery perfusion with lung-protective solution on lung morphous and function of dogs during cardiopulmonary bypass[J]. J4, 2008, 34(6): 975-979.

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