单侧肺循环阻断致肺缺血/再灌注损伤的特点  

Characterization of lung ischemia-reperfusion injury induced by blocking pulmonary artery and veins

作　　者：杨民[1] 许林[1] 任斌辉[1] 陈建[1] 蒋峰[1] 丁忠海[1] 张彤[1] 

机构地区：[1]南京医科大学附属江苏省肿瘤医院胸外科,江苏南京210009

出　　处：《医学研究生学报》2009年第6期592-595,I0004,共5页Journal of Medical Postgraduates

基　　金：江苏省社会发展重大项目基金资助项目(批准号:BS2006005);江苏省"333高层次人才培养工程"科研项目(批准号:苏人才办[2006]7号)

摘　　要：目的：单侧肺循环阻断是局部晚期中央型肺癌外科手术中常用措施之一。为了解单侧肺循环阻断时肺缺血/再灌注的特点,本文报道建立单侧肺循环阻断肺缺血/再灌注损伤动物模型,并与传统的单侧肺门阻断比较。方法：96只健康新西兰兔,随机分为3组：对照组36例;单侧肺循环阻断组30例;单侧肺门阻断组30例。术中监测动物血流动力学指标,分别于开胸时（对照组）、缺血1 h和再灌注1、2、4、6 h（对照组和2个实验组）取肺组织检测MDA、TNF-α和IL-8;取肺组织作病理学检查。结果：各组动物术中血流动力学指标平稳。缺血1 h和再灌注1、2、4、6 h,单侧肺循环阻断组和单侧肺门阻断组肺组织MDA与对照组比较有显著性差异（P〈0.05）,且单侧肺循环阻断组峰值滞后于单侧肺门阻断组。与对照组相比,单侧肺循环阻断组TNF-α峰值出现于再灌注2~4 h左右,单侧肺门阻断组出现于再灌注2 h;单侧肺循环阻断组和单侧肺门阻断组IL-8均于再灌注4 h明显高于对照组（P〈0.05）,再灌注6 h单侧肺循环阻断组和单侧肺门阻断组2组间有显著性差异（P〈0.05）。单侧肺循环阻断组于再灌注4 h出现较明显的肺损伤,单侧肺门阻断组则出现于再灌注2 h,且比单侧肺循环阻断组表现重。再灌注6 h 2组肺损伤均呈恢复趋势。结论：肺外科中单侧肺循环阻断可致肺缺血/再灌注损伤,但损伤程度比肺移植中的单侧肺门阻断轻。Objective： Blocking pulmonary artery and veins is a common surgical approach to the treat-ment of advanced central lung cancer. This study was to gain a better understanding of lung ischemia- reperfusion injury induced by blocking the pulmonary artery and veins by establishing a rabbit model. Methods： We randomly divided 96 New Zealand rabbits into Groups I （ controls, n = 36） , Ⅱ （ bloc- king the left pulmonary artery and veins, h = 30） , and Ⅲ （blocking the left pulmonary hilum, n = 30） , their lung tissues taken and subjected to pathological examination and determination of MDA, TNF-α and IL-8 at the time of opening the chest in the controls, and at 1 h after ischemia and 1, 2, 4 and 6 h after reperfusion for all the three groups. Results： There was significant difference in MDA between Group I and the other two （ P 〈 0.05 ）. After reperfusion, the level of TNF-α in the lung tissue peaked at 2 - 4 h in Group Ⅱ, but at 2 h in Group Ⅲ, and the content of IL-8 was significantly higher in Groups Ⅱ and m than in Group I at 4 h, with significant differences between the former two at 6 h （P 〈 0.05）. Obvious lung injury occurred at 4 h after reperfusion in Group Ⅱ , but at 2 h in Group Ⅲ, and a tendency of recovery was observed at 6 h in both the two groups. Conclusion ： In pulmonary transplantation, lung injury can be induced by blocking the pulmonary artery and veins, but it is milder than that induced by blocking the pulmonary hilum.

关 键 词：单侧肺循环阻断 缺血/再灌注 肺损伤 

分 类 号：R364.1[医药卫生—病理学]