单侧肺减容术肺切除量对肺气肿模型兔肺功能和肺泡形态学的影响(英文)  

Effects of unilateral lung volume reduction surgery with different resection volumes on pulmonary functions and alveolar morphology of emphysematous rabbits

作　　者：谭群友[1] 王如文[1] 蒋耀光[1] 龚太乾[1] 李东亮[1] 

机构地区：[1]解放军第三军医大学大坪医院野战外科研究所全军胸外科中心,重庆市400042

出　　处：《中国临床康复》2005年第23期251-253,共3页Chinese Journal of Clinical Rehabilitation

基　　金：重庆市科技攻关项目(20033301)~~

摘　　要：背景:重度阻塞性肺气肿时采用功能锻炼及保守治疗效果不佳。肺减容术是近年来治疗重度阻塞性肺气肿的有效方法,切除多少气肿肺组织才能实现最佳疗效。目的:评价单侧肺减容术后阻塞性肺气肿兔肺功能和肺泡形态学的变化,并比较肺切除量对两者的影响。设计:完全随机分组设计,对照实验。单位:解放军第三军医大学大坪医院全军胸外科中心。材料:实验于2003-08/2004-02在解放军第三军医大学大坪医院全军胸外科中心实验室完成。选用清洁级纯种雄性新西兰大白兔50只。随机分为5组,每组10只,分别为肺气肿组、小量肺减容术组、中量肺减容术组、大量肺减容术组和假手术组。方法:建立肺气肿模型:将50只兔置于自制有机玻璃箱内被动吸烟,每次点燃香烟(银象牌)15支,1次/d,持续30min,每周5次,连续7周。第4周时气管内注入猪胰弹性蛋白酶溶液3mL(2kU/kg)。分组干预:肺气肿组正常喂养,不进行手术。小量肺减容术组、中量肺减容术组、大量肺减容术组和假手术组肌注速眠新Ⅱ全麻后,仰卧位固定,气管插管(3mm内径),接HX-200型动物呼吸机机械通气,潮气量为12mL/kg,呼吸频率为40～50次/min。于右侧第4肋间入胸,小量肺减容术组切除右肺第一肺叶上外侧肺组织,中量肺减容术组切除右肺第一、二肺叶上外侧肺组织,大量肺减容术组切除右肺第一、二、三肺叶上外侧肺组织,切除量约各肺叶总量的1/2,切缘先用3-0无损伤缝线褥式缝合,然后喷注医用生物蛋白胶,以防术后漏气。假手术组只开胸,不切除肺组织。肺减容术后满8周时进行肺功能和肺组织形态学定量分析。主要观察指标:不同肺切除量的肺减容术后肺气肿兔的肺功能和肺泡形态定量分析。结果:进入结果分析兔50只,每组10只。①各组肺通气功能比较:中量肺减容术组的潮气量、第0.3秒用力呼气量和第0.3秒用力呼气BACKGROUND: Rehabilitation exercise and conservative treatment do not bring about good therapeutic effect for severe obstructive emphysema. And lung volume reduction surgery (LVRS) is an effective method for this kind of disease. How much emphysematous tissue should be resected in LVRS to achieve the best curative effect has been a concern. OBJECTIVE: To evaluate the pulmonary functional and alveolar morphologic changes in emphysematous rabbits after unilateral LVRS, and to compare the effects of different resection volumes. DESIGN: A completely randomized and controlled trial. SETTING: Thoracic Surgery Center of Daping Hospital of the Third Military Medical University of Chinese PLA. MATERIALS: This study was completed at the Laboratory of Thoracic Surgery Center of Daping Hospital of the Third Military Medical University of Chinese PLA from Frebruary 2003 to August 2003. Totally 50 New Zealand white male rabbits of cleaning grade were involved. These animals were divided randomly into groups of emphysema (A), less volume LVRS (B), middle volume LVRS (C), larger volume LVRS (D), and shame operation (E) . METHODS: Making of the rabbit emphysema model: Rabbits were put into an organic glass box and they inhaled passively smog produced from the cigarettes. Within seven weeks, 15 cigarettes (Yinxiang Brand) were lighted for about 30 minutes every time, once per day and five times a week. Elastase for 3 mL(2000 U/kg) from porcine pancreas (SERVA Co., Ltd) was injected into the rabbits' trachea in the fourth week. Intervention for different groups: Rabbits in Group A received no operation at all. Animals in other four groups were given general anesthesia by muscular injection of Sumianxin Ⅱ and they were then fixed supinely on the operation table. The rabbits were intubated with a 3-mm endotracheal tube and mechanically ventilated (HX-200 ventilator) with a tidal volume of 12 mL/kg and a respiratory rate of 40-50/minute. Thoracotomy was conducted through anterolateral incision of the fourth right intercostals area.

关 键 词：兔 肺气肿 阻塞性 肺减容术 肺功能 肺泡形态学 

分 类 号：R563[医药卫生—呼吸系统]