经左房灌注低钾右旋糖酐液对兔供体肺功能的保护作用  

Improved lung function by means of retrograde flush in the isolated lung transplantation in rabbits

作　　者：陈兴澎[1] 吴清玉[1] 杨秀滨[1] 王东[1] 温复兴[2] 史世勇[2] 刘小燕[3] 唐隶[3] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院外科,北京100037 [2]中国医学科学院中国协和医科大学麻醉体外循环研究室,北京100037 [3]中国医学科学院中国协和医科大学器官移植研究室,北京100037

出　　处：《中华实验外科杂志》2004年第6期707-710,i005,共5页Chinese Journal of Experimental Surgery

摘　　要：目的　通过左房及肺动脉灌注低钾右旋糖酐 (LPD)液 ,比较两种灌注方法对供体肺功能及结构的保护作用。方法　取 2 4只新西兰大白兔 ,随机分为经肺动脉灌注组 (AF组 ,n =6)与经左房逆行灌注组 (RF组 ,n =6) ,4℃保存 16h ;循环灌注过程 1h ;循环灌注期间每隔 10min测定动脉氧分压 (PaO2 )、动脉二氧化碳分压 (PaCO2 ) ;计算肺泡气动脉血氧分压差 (A aDO2 ) ;每隔 10min记录供体肺动脉压 (PaP)、气道峰压 (PawP) ;计算比较两组供体肺顺应性 (CL)及含水量的变化 ;光学显微镜、透射电镜分别观察两组供体肺移植前后的病理改变。结果　RF组供体肺在整个循环灌注过程中能基本保持良好的肺功能 ,灌注后 60min仍能保持PaO2 >84.96mmHg(1mmHg= 0 .13 3kPa) ;再灌注 2 0min后各时段 ,AF组氧合能力与RF组相比明显降低 (P <0 .0 1) ;至再灌注 5 0min后 ,AF组PaCO2 高于RF组 (P <0 .0 5 )。在移植 2 0min后各时段 ,AF组PaP均高于RF组 (P <0 .0 5 ) ;移植 3 0min后各时段 ,AF组PawP明显高于RF组 (P <0 .0 1) ;至再灌注末期RF组与AF组相比仍能保持较好的顺应性 (P <0 .0 1) ;移植后AF组供体肺含水量高于RF组 (P <0 .0 1)。光镜、透射电镜观察结果 :供体肺移植后 ,RF组肺泡结构完整 ,基本保持Ⅰ、Ⅱ型肺泡细胞的完整性。?Objective To evaluate the effects of retrograde flush with low potassium dextran glucose (LPD) solution via the left atrium in the isolated rabbits lung transplantation and compare with the routine antegrade flush.Methods On isolated lung transplantation model,24 rabbits were divided in two groups:group AF (the donor lung block was flushed with LPD (70 ml/kg) solution through the pulmonary artery) and group RF (retrograde flushing (70 ml/kg) was performed through the left atrium).The rabbits in both groups were stored at 4 ℃ for 16 h.Oxygenation capacity (PaO 2,PaCO 2),pulmonary compliance (PaP,PawP) were continuously monitored during the course of cyclic perfusion.The change of ultrastructure of donor lung was observed during transplantation.Results The PaO 2 in group RF were significantly higher than in group AF after 20 min of reperfusion (84.96 140.68mmHg vs 54.42 118.87 mm Hg P <0.01).Group RF had significantly better oxygenation capacity even after 60 min of reperfusion (PaO 2>84.96 mm Hg).PaCO 2 in group AF was higher than in group RF after 50 min of reperfusion (40.31 50.96 mm Hg vs 35.09 38.12 mm Hg P <0.05).PaP and PawP in group AF were higher than in group RF after 20,30 min of reperfusion ( P <0.001).Electron microscopy revealed that ultrastructure of donor lung in group RF was well preserved after 60 min of reperfusion,but in group AF,interstitial edema existed and in some regions the blood air barriers became thicker and broken.The contents of lamellar bodies in type II pneumocyte were reduced in both groups,especially in group AF.Conclusion The technique of retrograde flush via the left atrium could perfuse the donor lung well.For 16 h lung preservation with LPD solution,retrograde flush led to better graft function than the standard antegrade perfusion technique.

关 键 词：移植 肺 再灌注损伤 左心房 低钾右旋糖酐液 

分 类 号：R96[医药卫生—药理学]