婴幼儿未成熟肺缺血再灌注损伤的特点、机制与保护研究

发布时间：2021-11-05 09:50

　　肺缺血再灌注导致的损伤常见于外科临床,尤以应用体外循环（CPB）技术的各类手术及肺移植术后最为突出。术后肺功能障碍对患者的预后有着不容低估的影响,成为影响CPB术后恢复的非心血管并发症的首要因素。尤其是在婴幼儿先心病手术后,此类损伤已成为直接影响术后转归的最主要因素。对其发生机制的研究和寻求有效的防治措施是近年来国内外心血管外科共同关注的重要课题。研究者们致力于采用各种手段（如白细胞滤过、缺血预适应等）及药物干预（如糖皮质激素、氧自由基清除剂、蛋白酶抑制剂以及中药等）来预防或减轻肺缺血再灌注损伤,虽取得一定的效果,但这些方法对婴幼儿未成熟肺损伤的保护作用并不显著,相关方面的研究亦少见报道。因此,有必要对此类急性肺损伤病理生理过程进行再认识;积极探索未成熟肺损伤的特点;寻求进一步的、针对性的保护方法;以此达到改善婴幼儿体外循环术后肺功能及患者预后的目的;从而提高应用体外循环技术各类手术效果,特别是对婴幼儿先心病手术治疗水平具有重大意义和临床应用价值。据文献报道,在大量前炎性细胞因子TNF-α、IL-1β及ROS等通过炎性细胞表面TOLL受体将刺激信号传递到胞浆后,髓核细胞分化因子MyD8... 

【文章来源】：南京医科大学江苏省

【文章页数】：167 页

【学位级别】：博士

【文章目录】：
1.Abbreviations
2.Abstracts
    1)Abstract in Chinese
    2)Abstract in English
3.Introduction
    1)Ischemia-reperfusion(IR)and acute lung injury(ALI)in cardiothoracic surgery
    2)Animal models of lung IR injury(LIRI)
    3)The mechanisms of IR-induced lung injury in general
    4)The mechanisms of IR-induced lung injury in infants
    5)Current preventions and treatments of lung IR injury
    6)A new drug--Edaravone
4.Aims of the study
    1)Principal objectives
    2)Specific aims
5.Part Ⅰ
    1)Purpose
    2)Materials and methods
    3)Results
    4)Discussion
        ① Infant vs adult lung damage at light microscopic level
        ② Infant vs adult lung damage at electron microscopic level
        ③ Infant vs adult lung mitochondrial damage
        ④ Oxidative stress in infants vs adults
        ⑤ TNF-α,IL-1β,NF-κB and MyD88 in infants vs adults
6.Part Ⅱ
    1)Purpose
    2)Materials and methods
    3)Results
    4)Discussion
        ① ROS is one of the most important mediator of IR injury
        ② The choose of free radical scavenger-Edaravone
        ③ Dosing and timing of Edaravone
        ④ Therapeutic effects of Edaravone
7.Conclusions
8.Future studies and perspectives
    1.Molecular mechanism underlying IR-induced lung injury
    2.Prevention and treatment of IR-induced lung injury
9.References
10.Acknowledgements
11.List of publications
12.Appendix
    1)Papers
    2)Meetings



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