保护性有氧肺膨胀与移植肺保护形态学的研究  

Morphology of protective donor aerobic inflation and transplanted lung protection

作　　者：洪文娟 黄韬[1] 洪志鹏[1] 张璟[1] 尹小川[1] 太祥[1] 熊国盛[1] 赵炜[1] 杨学庆[1] 晋德光[1] 

机构地区：[1]昆明医科大学第一附属医院胸外科,云南昆明650032

出　　处：《中华肺部疾病杂志（电子版）》2012年第5期8-10,共3页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金(81060010);云南省教育厅科学研究基金(04z869c;05kjt16)

摘　　要：目的探讨实验性过度肺膨胀对供体肺脏保护的有害影响及肺移植中的保护性肺膨胀。方法杂种犬16只,随机分为对照组和实验组,建立肺过度膨胀动物模型。监测体循环动脉压及中心静脉压,实验组过度肺膨胀,对照组正常肺膨胀均为6h。通过光学显微镜和电子显微镜观察肺组织的病理形态学改变。结果①实验组体循环动脉压和中心静脉压与对照组比较差异无显著性(P>0.05);②病理和超微结构改变:实验组过度膨胀性肺损伤的程度明显大于正常肺膨胀的对照组。结论①超出呼吸生理极限的肺过度膨胀可导致不可逆性肺损伤;②灌注期间应保持供肺的充分膨胀,但不宜过度膨胀,以防止肺泡上皮和肺毛细血管内皮细胞受到不可逆性损伤;③供肺保存过程中应处于保护性肺膨胀状态,即正常膨胀的状态更加符合生理。Objective To investigate the detrimental impact of donor hyperinflation on pulmonary protection, and the safeguard of the protective lung inflation. Methods Sixteen mongrel dogs were randomly divided into control group and experimental group. Animal modal of lung hyperinflation of experimental group was established. The control group was kept normal inflation for six hours. Mean artery pressure, and central venous pressure were monitored continuously. Pathological change and ultramicroscopic structure of lung tissus were observed. Results （1）The mean artery pressure and central venous pressure were not variable markedly （ P 〉 0. 05 ） ; （2）Pathologic change and ultramicroscopic structure： the degree of lung injury was grossly more serious in the experimental group than the control group. Conclusion （1）Pulmonary hyperinflation beyond respiratory physiological limit can cause irreversible injury of lung; （2）Donor lung should be completely inflated during pulmonary arterial perfusion, but not suitable hyperinflation, to guard against irreversible injury of pulmonary alveolar epithelia cell and capillary endothelial cell; （3）The lung should be in a state of protective normal inflation during graft lung preservation, and this status is still more coincidence physiology.

关 键 词：肺移植 肺保护 肺保存 

分 类 号：R655.3[医药卫生—外科学]