含抑肽酶低温灌注液减轻体外循环肺损伤  

Pulmonary Artery Pefusion with Hopythermic Solution Containing Aprotinin Reduce Lung Injury after Cardiopulmonary Bypass

作　　者：王强[1,2,3] 刘迎龙[1,2,3] 朱晓东[1,2,3] 潘世伟 阮英茆[1,2,3] 李永利 

机构地区：[1]中国医学科学院 [2]中国协和医科大学心血管病研究所 [3]阜外心血管病医院先心病研究室

出　　处：《中华胸心血管外科杂志》1999年第3期177-179,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金

摘　　要：目的：研究体外循环（ＣＰＢ）期间低温保护液肺动脉灌注对肺脏的保护作用。方法：１２只杂种犬随机均分为２组。主动脉阻断后，对照组右肺动脉灌注４℃乳酸林格液，实验组灌注４℃肺保护液。开放主动脉后和停ＣＰＢ后５、３０、６０、９０分钟；分别取各组肺静脉血标本行生化分析，测定肺功能，并行组织学检查。结果：ＣＰＢ结束后实验组气道压、肺血管阻力（ＰＶＲ）、右房血白细胞／右肺静脉血白细胞及丙二醛（ＭＤＡ）显著低于对照组（Ｐ＜０．０５）；两组右肺静脉血氧分压在ＣＰＢ结束后３０、６０分钟均较左肺高，实验组右肺静脉血氧分压在停ＣＰＢ６０分钟时显著高于对照组（Ｐ＜０．０５）；组织学观察两组左肺均有明显肺泡内出血和间质水肿，对照组右肺病理改变较左肺轻，实验组右肺组织结构基本正常。结论：ＣＰＢ期间肺动脉灌注低温肺保护液可以明显减轻ＣＰＢ对肺脏造成的损伤。Objective:The aim of this study was to determine the effect of pulmonary perfusion with hypothemic protective solution on lung function during cardiopulmonary bypass(CPB).Method:Twelve adult mongrel dogs were randomly divided into the two groups.During CPB,the right pulmonary artery was perfused with 4 lactated Ringer's solution in control group and with 4 protective solution in study group.After aortic crossclamp was released,animals were weaned from CPB.The plasma malondialdehyde(MDA),white blood cells and lung function were measured and lung biopsies were also obtained.Results:After CPB airway pressure and pulmonary vascular resistance(PVR) was reduced significantly in study group than that in control group (P<0.05).At the 30,60 minutes after CPB,the PO2 of right pulmonary venous was significanlty better than that of left pulmonary venous in both groups.The PO2 of right pulmonary venous was significantly higher than that of left at the 60 minutes after CPB in study group(P<0.05).White cell ratio of right atrium to right pulmonary venous and MDA was significanlty lower at 5 minutes after crossclamp release in study group was compared with control group(P<0.05).Histologic evaluation revealed the left lung of both groups had markedly intraalveolar hemorrhage and interstitial edama.The right lung of control group had less pathological changes was compared with the left lung.The study group had normal lung architecture.Conclusion:This study demonstrated that pulmonary artery perfusion with the hypothernic protective solution can obviously reduce lung injury after cardiopulmonary bypass.

关 键 词：体外循环 抑肽酶 肺动脉灌注 肺损伤 治疗 

分 类 号：R655.305[医药卫生—外科学] R654.1[医药卫生—临床医学]