单肺通气并左心转流前后两侧肺组织生化及形态学改变的实验观察  

Biochemical and Morphological Changes in Collapsed and Ventilated Lungs Before and After One Lung Ventilation With Left Heart Bypass

作　　者：屈正[1] 孙衍庆[1] 董培青[1] 任发成[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科

出　　处：《中国循环杂志》1998年第2期114-116,共3页Chinese Circulation Journal

摘　　要：目的：观察犬单侧肺通气并左心转流前后通气侧与萎陷侧肺组织生化及病理形态的变化。方法：对８只犬建立单侧肺通气并左心转流模型，阻断降主动脉近、远端时间１０５±１６分，控制左心房压小于１．６０ｋＰａ（１２ｍｍＨｇ）。测定血浆凝血烷Ｂ２（血栓素Ｂ２，ＴＸＢ２）和６－酮－前列腺素Ｆ１α（６－ｋ－ＰＧＦ１α）含量及肺组织血管紧张素转换酶活性、丙二醛含量、超氧化物歧化酶活性、组织病理形态等。结果：转流６０分左心房血浆ＴＸＢ２／６－ｋ－ＰＧＦ１α较前增高１９％（Ｐ＜０．０５）。转流后萎陷侧肺静脉血比值较前增高３５％（Ｐ＜０．０５），并明显高于通气侧肺静脉（Ｐ＜０．０５）；而通气侧较前无显著改变。转流后萎陷侧肺组织与转流前同侧肺和转流后通气侧肺比较，丙二醛含量升高，超氧化物歧化酶活性和血管紧张素转换酶活性降低。但双肺皆无明显形态学改变。结论：单肺通气并左心转流期间萎陷侧肺存在不伴有形态学改变的缺氧代谢。? Objective:In order to investigate the biochemical and morphological changes in both ventilated and collapsed lung during onelung ventilation and left heart bypass(LHB). Methods:Onelung ventilation and left heart bypass was performed in eight canines.The bypass time was about 105±16 min and the left atrial pressure was controlled at less than 160 kPa(12 mmHg) during LHB.The plasma thromboxane B2(TXB2)/6kPGF1α and angiotension converting enzyme(ACE) activity,malondialdehyde(MDA) content,superoxide diamutase(SOD)activity and pathological morphology of the lung tissue were studied. Results:The plasma TXB2/6kPGF1α of left atrium markedly increased(p<005) when bypass for 60 min.The venous TXB2/6kPGF1α ratio of collapsed lung was significantly higher than before LHB and that of ventilated lung at the end of LHB(p<005),while it had no change in ventilated lung as compared with before LHB.The MDA content was significantly increased(p<005),ACE and SOD activity were decreased (both p<005) in collapsed lung as compared to those before LHB and of ventilated lung.There were no apparent pathological and ultrastructural changes observed in either ventilated or collapsed lung during LHB with normal left atrial pressure. Conclusion:The anoxic metabolism is present in collapsed lung without morphological change during onelung ventilation and left heart bypass.

关 键 词：单肺通气 左心转流 麻醉 心外科手术 

分 类 号：R654.2[医药卫生—外科学]