双心室体外循环的肺保护作用  

Biventricular bypass attenuates CPB-caused lung injury

作　　者：孔祥[1] 黄惠民[2] 马良龙[2] 范慧敏[1] 赵曙光[1] 刘中民[1] 

机构地区：[1]同济大学附属东方医院心胸外科,上海200120 [2]上海交通大学附属新华医院上海儿童医学中心心胸外科,上海200127

出　　处：《同济大学学报（医学版）》2007年第5期102-106,共5页Journal of Tongji University(Medical Science)

基　　金：国家自然科学基金资助项目(30170929)

摘　　要：目的探讨用自体肺氧合的双心室体外循环是否比采用膜肺氧合的常规体外循环对肺组织有更好的保护作用。方法将12只小猪随机分为双心室体外循环组(实验组)和常规体外循环组(对照组)。双心室体外循环方法是在升主动脉、左右心耳和肺动脉插管后,通过左心耳和升主动脉插管组成左心灌注系统,通过右心耳和肺动脉插管组成右心灌注系统。两组均测定转流前、阻断主动脉60min和转流结束时的肺静态顺应性。测定试验前后两组的肺泡-动脉氧分压差。检测实验前后灌注液中肿瘤坏死因子-α(Tumor necrosis factor-alpha,TNF-α)、白介素-6(inter-leukin-6,IL-6)变化。实验结束时取左下肺小块组织测湿干比并进行光镜和电镜观察。结果实验组肺静态顺应性、湿干比指标均明显优于对照组(P<0.05),灌注液中的TNF-α含量显著低于对照组(P<0.05),光镜和电镜下的肺损伤程度轻于对照组。结论双心室体外循环较之常规体外循环对肺组织有较好的保护作用。Objective To study if using autologous lung as oxygenator in a biventricular bypass （BVB） can reduce lung injury after cardiopulmonary bypass（CPB）. Methods Twelve piglets were randomly divided into two groups. Control group underwent standard CPB. Experimental group underwent BVB with autolougous lung perfusion. In experimental group,four cannulas were inserted into aorta, left and right atrium, and main pulmonary artery respectively. The right ventricular bypass was formed by right atrium, a blood reservoir, a roller pump and the main pulmonary cannula. The left ventricular bypass was formed by left atrium, a blood reservoir, a roller pump and aorta cannula. In two groups, the lungs＇ compliances were measured before bypass, one hour after clamping, and at the end of the bypass. The contents of TNF- α, IL- 6 and the alveolar to arterial oxygen gradient（PA-aO2） were assessed before and after bypass. The wet to dry lung weight ratios （W/ D） were calculated after bypass. Histological and ultrastructural changes of the lung were also examined after bypass. Results The lung compliance and the W/D in experimental group were significantly better than those in the control group. The content of TNF- α in experimental group was significantly lower than that in control group. It also demonstrated milder lung injury in experimental group through light and electrical microscope. Conclusion Using BVB can reduce lung injury after CPB.

关 键 词：体外循环 肺 缺血再灌注损伤 

分 类 号：R654.1[医药卫生—外科学]