控制性犬肺萎陷与肺早期损伤的相关性

发布时间：2018-06-28 16:51

本文选题：单肺通气 + 肺萎陷程度　；参考：《广东医学》2017年15期

【摘要】：目的利用一种新型肺隔离通气工具,探讨开胸手术控制犬肺萎陷与肺早期损伤的相关性。方法按完全随机法将18只实验犬分为3组(G1组、G2组、G3组),全身麻醉后插入控制肺内平衡分气肺隔离导管,股动、静脉穿刺置管,右颈内静脉置入Swan-Ganz漂浮导管,首先均双肺通气(two lung ventilation,TLV)20 min,后进行左侧单肺通气(one lung ventilation,OLV),萎陷程度依次为100%(G1组)、90%(G2组)、50%(G3组),分别在肺萎陷前(T0),肺萎陷后30 min(T1)、60 min(T2)、120 min(T3)经股动脉和颈静脉取血液标本行血气分析测定分流率(Qs/Qt),ELISA测定血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)含量;实验中持续监测股动脉血压、心率、肺动脉压等生理数据,在T3时取肺组织检测肺组织湿干重比(wet/dry weight ratio,W/D);病理切片HE染色,显微镜观察并盲法评分比较肺组织病理学变化。结果各组在TLV时测得的各方面生理指标均差异无统计学意义(P0.05);OLV后,与G1组比较,G2、G3组平均肺动脉压(MPAP)较为平稳,差异有统计学意义(P0.05);肺内分流率Qs/Qt、W/D及TNF-α、IL-6含量降低,肺组织水肿、出血、炎症细胞浸润程度及肺损伤评分降低。G2组与G3组在各时间点的各项指标差异无统计学意义(P0.05)。结论与完全肺萎陷(萎陷程度100%)相比,控制性肺萎陷(萎陷程度90%和50%)能更好地减轻术中肺损伤,但萎陷程度90%与50%之间未见明显差异。
[Abstract]:Objective to investigate the relationship between lung collapse control and early lung injury in dogs with open chest surgery using a new lung isolation ventilation tool. Methods Eighteen dogs were randomly divided into 3 groups (G _ 1 group, G _ 2 group and G _ 3 group). After general anesthesia, the Swan-Ganz floating catheter was inserted into the right internal jugular vein. The degree of wilting was 100% (G1 group) 90% (G2 group) 50% (G3 group) respectively before lung collapse (T0) and 30 min (T1) 60 min (T2) after lung atrophy. Blood samples were collected from femoral artery and jugular vein for 120 min (T3). Serum tumor necrosis factor- 伪 (TNF- 伪) and interleukin-6 (IL-6) were determined by Elisa. The physiological data of femoral artery blood pressure, heart rate and pulmonary artery pressure were continuously monitored. Lung tissues were taken at T3 to detect wet/dry weight wet / dry weight ratio (WR / D), pathological sections were stained with HE, observed by microscope and compared with pathological changes by blind method. Results after OLV, the mean pulmonary artery pressure (MPAP) of G2G3 group was more stable than that of G1 group (P0.05), and the mean pulmonary artery pressure (MPAP) of G2G3 group was significantly higher than that of G1 group (P0.05). Bleeding, inflammatory cell infiltration and lung injury score decreased. G2 group and G3 group at each time point in the index difference was not statistically significant (P0.05). Conclusion compared with complete lung collapse (100%), controlled pulmonary atrophy (90% and 50%) can reduce lung injury more effectively, but there is no significant difference between 90% and 50%.
【作者单位】：南方医科大学南方医院麻醉科;中山大学中法核工程与技术学院;复旦大学中山医院耳鼻喉科;中山大学孙逸仙纪念医院麻醉科;
【基金】：广东省科技计划项目(编号:2016B090918111)
【分类号】：R614

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