部分液体通气参与体外循环肺损伤保护的基础研究  

Protective effect of partial liquid ventilation against lung injury after cardiopulmonary bypass: an experimental research

作　　者：谢业伟[1,2] 郑景浩[3] 张儒舫[1,2] 吴容[1,2] 龚瑾[1,2] 

机构地区：[1]上海市儿童医院 [2]上海交通大学附属儿童医院小儿心胸外科,200040 [3]上海交通大学医学院附属儿童医学中心小儿心胸外科

出　　处：《上海医学》2011年第8期629-633,565,共5页Shanghai Medical Journal

摘　　要：目的通过体外循环(CPB)肺损伤动物模型,探讨以全氟化碳(PFC)为媒介的部分液体通气(PLV)对深低温CPB肺损伤的保护作用及机制。方法建立CPB动物实验模型。20只幼猪随机分为对照组(CPB组)和实验组(CPB+PLV组):对照组只行单纯CPB;实验组在CPB停后即刻经气管插管向幼猪肺内灌入FC-77。实验组与对照组以同样的呼吸参数行机械通气。分别于CPB前、CPB停后即刻、CPB停后1及2 h抽取动脉血,行动脉血气分析及血清中炎性因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-8和IL-6]含量检测。于实验结束即刻取左下肺小块组织,经过实验室处理,观察肺组织组织黏附分子(ICAM-1)的表达和组织形态学变化。结果实验组CPB停后2 h,TNF-α、IL-8、IL-6均显著低于对照组(P值均<0.05)。实验组CPB停后1、2 h,动脉血氧分压(paO2)显著高于对照组(P值均<0.05),动脉血二氧化碳分压(paCO2)显著低于对照组(P值均<0.005)。光学显微镜下实验组肺损伤程度明显轻于对照组。CPB停后对照组肺组织中ICAM-1的表达呈强阳性,实验组呈弱阳性。结论PLV对CPB肺损伤有较好的保护作用,可能与改善paO2和抑制TNF-α表达有关。Objective To investigate the protective effect of partial liquid ventilation（PLV） with perfluorocarbon（PFC） against lung injury after cardiopulmonary bypass（CPB） and the related mechanism in an animal model.Methods Twenty piglets were randomly divided into two groups： CPB group（control group,n=10） and CPB＋PLV group（experimental group,n=10）.Animals in the control group only received CPB,and those in the experimental group received PFC（12 mL/kg） into the trachea immediately after CPB.The two groups were given mechanical ventilation with same parameters.The gas exchange in arterial blood samples and serum tumor necrosis factors-α（TNF-α）,interlukin-8（IL-8） and IL-6 were mearsured at pre-CPB,0 h,1 h and 2 h after CPB.Lung specimens were taken from left lower lung at the end of CPB so as to to observe the expression of adhesion factor Inter-cellular adhesion molecule 1（ICAM-1） and histological changes.Results Compared with control group,the experimental group had significantly lower levels of TNF-α,IL-8 and IL-6 2 h after CPB（P0.05）.Compared with control group,animals in the experimental group had significantly higher arterial partial pressure of oxygen（paO2） level（P0.05） and lower arterial partial pressure of carbon dioxide（paCO2） level 1 h and 2 h after CPB（P0.05）.Histologic findings showed slighter lung injury in the experimental group than in the control group.After CPB,expression of ICAM-1 was strong in the control group and weak in the experimental group.Conclusion PLV can protect lung after CPB,which might be related to improvement of paO2 and inhibition of TNF-α.

关 键 词：体外循环 全氟化碳 部分液体通气 肺损伤 

分 类 号：R726.5[医药卫生—儿科]