左西孟旦对犬体外循环术后肺保护的实验研究

发布时间：2018-05-05 07:24

  本文选题：左西孟旦 + 体外循环　； 参考：《安徽医科大学》2015年硕士论文

【摘要】：背景:体外循环(CPB,cardiopulmonary bypass)技术的发展在心脏外科中具有里程碑的意义,使得心内直视技术得以开展,但同时CPB术后的并发症严重影响了术后患者的临床转归,尤其是CPB术后急性肺损伤(ALI,actue lung injury),增加了术后的并发症延长了ICU住院时间,增加了术后死亡率。CPB术后ALI机制目前尚未明确,但可能与CPB术后全身炎症反应(SIRS,systemic inflammatory response syndrome),缺血灌注损伤(I/R,ischemia-reperfusion injury)、细胞凋亡、机械物理因素的损伤等多种因素有关,左西孟旦(LS,Levosimendan)作为新一代钙增敏剂,于2000年首次在瑞典上市,其具有明显提高心肌收缩力的作用,而且还不增加细胞耗氧,临床上已用该药治疗各种急性心力衰竭等病症。LS还具有明显抗缺血再灌注损伤、抗细胞凋亡及减少炎症因子产生的作用,有学者证明LS还具有脏器保护作用。目的:探索左西孟旦(LS)对实验用杂种犬体外循环(CPB)术后急性肺损伤(ALI)是否具有保护作用。方法:实验用杂种犬32只,随机分为4组,对照组(C组),氧和冷血肺动脉灌注组(P组),LS静脉注射组(LSIV);含LS的氧和冷血肺动脉灌注组(LSP组),LS的剂量均为65 g/kg;检测各组肺组织中丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性,光镜及电镜观察肺组织的病理形态学变化。结果:肺组织中MDA含量及SOD活性,与C组相比,LSP组、P组及LSIV组MDA含量明显降低,且SOD活性明显升高(P0.05),与LSP组相比,LSIV组及P组MDA含量明显升高,且SOD活性明显降低(P0.05),P组和LSIV组无统计学意义(P0.05)。结论:通过犬动物实验模型,单纯肺动脉灌注、肺动脉灌注及静脉注射LS,MDA含量明显减少,SOD活性增高,对肺组织具有保护作用。
[Abstract]:Background: the development of cardiopulmonary bypass (CPB) is a milestone in cardiac surgery, which makes the open heart vision technology develop. However, the complications after CPB seriously affect the clinical outcome of the patients. Especially, the mechanism of acute lung injury after CPB is not clear, which increases the postoperative complications and prolongs the hospitalization time of ICU, and increases the postoperative mortality. CPB.The mechanism of ALI after operation is not clear. But it may be related to many factors, such as systemic inflammatory response after CPB, I / R / reperfusion injury, apoptosis, injury of mechanical and physical factors, etc., as a new generation of calcium sensitizer, Levosimendan, a new type of calcium sensitizer, was first listed in Sweden in 2000. It can obviously improve myocardial contractility, and does not increase cell oxygen consumption. It has been used to treat all kinds of acute heart failure. LS also has obvious anti-ischemia-reperfusion injury. Anti-apoptosis and reducing the production of inflammatory factors, some scholars prove that LS also has organ protection. Aim: to investigate the protective effect of LSs on acute lung injury (ALI) after CPB in experimental mongrel dogs. Methods: Thirty-two mongrel dogs were randomly divided into 4 groups. Control group C, oxygen and cold blood pulmonary artery perfusion group P group LSIVD, LS-containing oxygen group and cold blood pulmonary artery perfusion group LSP dose were 65 g / kg, the content of malondialdehyde (MDA) MDAs and the activity of superoxide dismutase (SOD) in lung tissue of each group were measured. The histopathological changes of lung tissue were observed by light microscope and electron microscope. Results: compared with group C, the content of MDA and the activity of SOD in lung tissue decreased significantly in group P and group LSIV, and the activity of SOD increased significantly (P 0.05), and the content of MDA in group C and group P was significantly higher than that in group LSP. Moreover, the activity of SOD was significantly decreased in P 0.05 P group and LSIV group, and there was no significant difference between P 0.05 group and LSIV group. Conclusion: in canine animal model, pulmonary artery perfusion, pulmonary artery perfusion and intravenous injection of LSMDA can significantly reduce the increase of SOD activity and have protective effect on lung tissue.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.1
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本文编号：1846778