经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性  

The effectiveness and superiority of establishing the airway bypass through bronchoscopic radio frequency catheter lung volume reduction in the sheep model of pulmonary emphysema

作　　者：冯志军[1,2] 路武杰[2] 郭俊华[2] 黄志昂[2] 王红燕[2] 靳建军[1] 王静[1] 

机构地区：[1]郑州大学第一附属医院呼吸与危重症医学科,河南郑州450052 [2]河南大学第一附属医院呼吸内科,河南开封475001

出　　处：《西安交通大学学报（医学版）》2013年第6期829-832,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：河南省卫生厅医学科技攻关项目(No.200903107);河南省教育厅自然科学研究资助项目(No.2009A320002);河南科技厅科技发展计划项目(No.092102310064)~~

摘　　要：目的探讨经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性。方法将16只6月龄雌性绵羊随机分为A、B两组,木瓜蛋白酶方法建立肺气肿模型。A组经纤支镜射频建立气道旁路并放置支架,同时给予内科治疗,B组仅给予内科治疗。分别测两组绵羊术前和术后24h、4周、8周的第1秒用力呼气容积(forced expiratory volume in one second,FEV1.0),且进行比较;A组定期行胸部CT检查,治疗8周处死动物,行病理学检查。结果成功复制绵羊肺气肿动物模型16只,A组术前、术中、术后无明显异常;A组胸部CT示术后4周及8周,在治疗区均出现肺容积缩小,出现肺不张表现;两组不同时间点FEV1.0水平差异有统计学意义(F时间=1 352.409,P<0.001),两种治疗手段效果差异有统计学意义(F组间=5 004.278,P<0.001),治疗手段和时间之间有交互作用(F交互=1 325.058,P<0.001);病理示A组治疗区见肺泡萎陷区,非治疗区域见肺气肿,肺泡萎陷区见粒细胞和淋巴细胞浸润;B组见肺气肿的肺泡组织。结论该技术治疗绵羊肺气肿模型具有有效性及优越性。Objective To explore the effectiveness and superiority of establishing the airway bypass through bronchoscopic radio frequency catheter lung volume reduction in the sheep model of pulmonary emphysema. Methods Sixteen female sheep aged 6 months were randomly divided into Group A and Group B; emphysema model was established by means of papain administration. The airway bypass was constructed in Group A through bronchoscopic radio frequency catheter and both groups received medical treatment. The forced expiratory volume in one second （FEV1.0） of each sheep was measured and compared before treatment, and 24 hours, 4 weeks and 8 weeks after treatment; chest CT of Group A was examined regularly. All the sheep were executed 8 weeks after treatment for pathological examination. Results Pulmonary emphysema model was successfully copied in 16 sheep. Group A did not have obvious abnormalities pre-operatively, intraoperatively or post-operatively. Reduced lung volume of the treatment area and atelectasis were shown on the chest CT of Group A 4 weeks and 8 weeks after operation. There were significant differences in FEV1.0 level at different time points （Ftim~ = 1 352. 409, P^0. 001） and in therapeutic effectiveness （Fgroup = 5 004. 278, P（0. 001）. The means and time of treatment were interactive （ftime. group ~ 1 325. 058, P^0. 001）. Pathological examination showed alveolar atelectatic area in the treated area, emphysema in the non-treated area, and granulocyte and lymphocyte infiltration in alveolar atelectatic area in Group A. Alveolar tissue emphysema was observed in Group B. Conclusion Establishing the airway bypass through bronchoscopic radio frequency catheter lung volume reduction is effective and superior in medical treatment of sheep model of pulmonary emphysema.

关 键 词：纤维支气管镜肺减容术 射频置管 气道旁路 肺气肿 有效性 优越性 

分 类 号：R563.3[医药卫生—呼吸系统]