小香猪DCD边缘供体模型的构建及其供肾病理学观察  

Construction of porcine DCD marginal donor model and pathological observation of donor kidney

作　　者：刘祥凤 陈倩 秦志刚 杨子恒 李翼容 黎洁钰 薛正威 高仁君 陈星同 许月明 肖亚 顾健腾 LIU Xiangfeng;CHEN Qian;QIN Zhigang;YANG Ziheng;LI Yirong;LI Jieyu;XUE Zhengwei;GAO Renjun;CHEN Xingtong;XU Yueming;XIAO Ya;GU Jianteng(Department of Anesthesiology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038;Department of Anesthesiology,No.958 Hospital of PLA Army,Chongqing,400020;Department of Urology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆400038 [2]陆军第958医院麻醉科,重庆400020 [3]陆军军医大学(第三军医大学)第二附属医院泌尿外科,重庆400037

出　　处：《陆军军医大学学报》2023年第5期426-432,共7页Journal of Army Medical University

基　　金：国家自然科学基金青年科学基金(81801900);重庆市自然科学基金面上项目(cstc2018jcyjAX0007);陆军军医大学人才基金(XZ-2019-505-028)。

摘　　要：目的建立一种小香猪心脏死亡后器官捐献(donation after cardiac death,DCD)供体模型,并对DCD供肾进行病理学评价。方法7只4~6月龄的雄性小香猪(13~17 kg)分为标准供体对照组(C组,n=3)和DCD组(n=4),两组肌注苯巴比妥钠麻醉诱导后,建立耳缘静脉通道,行血压、心电图和氧饱和度(SaO_(2))监测,同时注射丙泊酚、舒芬太尼强化麻醉诱导效果。C组气管插管后机械通气,丙泊酚、瑞芬太尼和顺阿曲库铵维持麻醉,行开腹术摘取肾脏;DCD组静脉推注肝素(300 IU/kg)抗凝,后注射丙泊酚600 mg和顺阿曲库铵10 mg使猪心跳呼吸停止,待心停跳30 min时摘取肾脏。2组肾脏均切成小块组织,4%多聚甲醛固定,行石蜡包埋,采用HE染色,光镜下观察正常肾脏和DCD边缘供体肾脏的病理结果变化并进行组织损伤评分。结果DCD组共成功建模4只猪在注射过量麻醉药后SaO_(2)下降至80%的平均时间为(3.25±1.89)min,心脏骤停平均时间为(7.75±3.10)min;热缺血30 min后获取的DCD边缘供肾与C组供肾相比,肾小管损伤评分增高(P<0.05),肾小球损伤评分均值增高,但差异无统计学意义。结论采用静脉注射过量丙泊酚和顺阿曲库铵的方法可有效建立猪DCD边缘供体模型。ObjectiveTo construct a marginal donor model of porcine donation after cardiac death(DCD),and evaluate the pathological alteration of DCD donor kidneys.MethodsSeven male mini pigs(4~6 months old,13~17 kg)were divided into standard donor control group(C group,n=3)and DCD group(n=4).After intramuscular injection with phenobarbital sodium,their auricular vein channels were established,then propofol and sufentanil were injected to enhance the anesthetic induction while blood pressure,electrocardiogram and oxygen saturation(SaO_(2))were monitored at the same time.Group C received mechanical ventilation after endotracheal intubation,and maintained anesthesia with propofol,remifentanil and cisatracurium,and the kidneys were harvested under laparotomy.In the DCD group,300 IU/kg heparin was injected intravenously for anticoagulation,followed by single bolus venous injection with 600 mg propofol and 10 mg cisatricurium to induce cardiac and respiratory arrest,and finally,the kidneys were harvested in 30 min after cardiac arrest.The kidneys in both groups were cut into small tissues,which were further fixed with 4%paraformaldehyde,embedded in paraffin wax and stained with HE for the pathological assessment and tissue damage scores under a optical microscope.ResultsThe mean time for SaO_(2)to decline to 80%was 3.25±1.89 min and the mean time for cardiac arrest was 7.75±3.10 min in the 4 pigs of DCD group after injection with overdose of anesthetics.Compared with the C group,the renal tubular injury score of DCD marginal donor kidney after suffering from warm ischemia for 30 min,was higher(P<0.05),and the mean score of glomerular injury was increased through no statistical difference.ConclusionIntravenous injection of excessive propofol and cisatracurium can effectively establish a porcine DCD marginal donor model.

关 键 词：心脏死亡器官捐献 边缘供体 器官移植 动物模型 猪 

分 类 号：R-332[医药卫生] R322.61R361