经纤维支气管镜生物性肺减容术的动物实验  

BIOLOGICAL LUNG VOLUME REDUCTION IN ANIMAL BY BRONCHOFIBROSCOPE

作　　者：罗美群[1] 黎雨[1] 柳广南[1] 黄斯明[1] 苏红[1] 

机构地区：[1]广西医科大学第一附属医院呼吸内科,南宁530021

出　　处：《广西医科大学学报》2011年第2期182-186,共5页Journal of Guangxi Medical University

基　　金：广西自然科学基金资助项目(No.桂科自0991132)

摘　　要：目的：探讨生物性肺减容术糜蛋白酶代替胰蛋白酶的合适剂量、国产生物蛋白胶中纤维蛋白原与凝血酶的最佳配比、706代血浆替换小牛血清的可行性。方法：9头健康约克幼猪（体重16-22 kg）分别标记1-9号。第一阶段用不同剂量（A,B两种）糜蛋白酶和不同配比（A’,B’两种）生物蛋白胶配伍加上小牛血清通过纤维支气管镜给药于1-4号猪。观察术前、术后1周,术后1,3个月肺部影像学改变及测定肺容积,术后3个月时取出动物肺脏,观测形态学及病理改变。第二阶段根据以上结果用最佳的糜蛋白酶和生物蛋白胶剂量配伍给药于5-9号猪,但用706代血浆替换小牛血清。结果：①使用糜蛋白酶剂量较小的1,2号猪3个月后靶肺段无显著缩小,质地柔软,病理未见肺组织纤维化改变;3号猪采用文献中生物蛋白胶原配方发现蛋白胶很快凝固且阻塞支气管腔,造成肺脓肿破溃后移至膈肌上引起广泛粘连;术后3个月,4号猪右肺容积/总肺容积于术前56.8%下降至51.6%,且靶区有纤维化表现,病理见纤维结缔组织增生,肺不张和炎症细胞浸润。②使用706代血浆替代小牛血清实验可使实验动物的靶目标肺段容积/总肺容积于术后3个月较术前明显减小和明显纤维化改变。结论：生物肺减容术中糜蛋白酶可以替代胰蛋白酶,706代血浆可以替代小牛血清,糜蛋白酶B＋706代血浆＋生物蛋白胶B’的配伍用药可使试验动物的靶目标肺段塌陷和肺纤维化且无严重并发症发生,从而达到肺减容的目的,以上肺减容术方法有望在临床应用。Objective：To study the optimal dose of chymotrypsin replacement to trypsin,the best match between fibrin and thrombin in fibrin hydrogel,and the possibility of 706 reagent replacement to fetal bovine serum in biological lung volume reduction（BLVR）.Methods：Nine young pigs（16~22 kg） were individually marked by NO.1 to NO.9.In the first step：BLVR was performed for four pigs（NO.1 to NO.4）with different dose of chymotrypsin and fibrin hydrogel.All animals were done by chest helical computed tomography scanning before BLVR and at 1 week,1 month,3 months after BLVR,then the pigs were killed and their whole lungs were harvesred,photographed and examined histologically at 3 months later.Then the four reagents projects were evaluated and selected the best one to perform the BLVR in the second step＇,in which the fetal bovine serum was replaced with the 706 reagent.Results：① Chest CT volume evaluation showed that the volume of right lung/total lung in Pig 1（before BLVR 51%→3 month later 56.8%） and Pig 2（44.4%→55.2%） was not to decreased,but in Pig 3（57.6%→45.7%）,Pig 4（56.8%→51.6%）,so on was significantly decreased.The target subsegment of the lungs of Pig 1 and Pig 2 looked as the same as the other lung,they were touched softly and didn＇t adhere to the adjacent chest wall.The target subsegment of the lung of Pig 3 looked phoeniceous and adhered to the adjacent chest wall badly,and a smooth lump,the size of which was 3.5 cm×3.5 cm,was found on the diaphragmatic surface adjacent to the target lung segment.Microscopic observation included target segment fibrosis,necrotic tissue and lung abscess formation.The target subsegment of the lung of Pig 4 looked grey,solider,smaller and adhered to the adjacent chest wall slightly.Microscopic observation of it included fibrosis,atelectasis and inflammatory cell infiltration.②It also showed that 706 reagent could replaced with fetal bovine serum and resulted in significant lung volume reduction in the target segment.Conclusion：In the

关 键 词：肺减容术 纤维支气管镜 生物蛋白胶 肺纤维化 

分 类 号：R-33[医药卫生]