摘要
目的利用一种新型肺隔离通气工具,探讨开胸手术控制犬肺萎陷与肺早期损伤的相关性。方法按完全随机法将18只实验犬分为3组(G1组、G2组、G3组),全身麻醉后插入控制肺内平衡分气肺隔离导管,股动、静脉穿刺置管,右颈内静脉置入Swan-Ganz漂浮导管,首先均双肺通气(two lung ventilation,TLV)20 min,后进行左侧单肺通气(one lung ventilation,OLV),萎陷程度依次为100%(G1组)、90%(G2组)、50%(G3组),分别在肺萎陷前(T0),肺萎陷后30 min(T1)、60 min(T2)、120 min(T3)经股动脉和颈静脉取血液标本行血气分析测定分流率(Qs/Qt),ELISA测定血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)含量;实验中持续监测股动脉血压、心率、肺动脉压等生理数据,在T3时取肺组织检测肺组织湿干重比(wet/dry weight ratio,W/D);病理切片HE染色,显微镜观察并盲法评分比较肺组织病理学变化。结果各组在TLV时测得的各方面生理指标均差异无统计学意义(P>0.05);OLV后,与G1组比较,G2、G3组平均肺动脉压(MPAP)较为平稳,差异有统计学意义(P<0.05);肺内分流率Qs/Qt、W/D及TNF-α、IL-6含量降低,肺组织水肿、出血、炎症细胞浸润程度及肺损伤评分降低。G2组与G3组在各时间点的各项指标差异无统计学意义(P>0.05)。结论与完全肺萎陷(萎陷程度100%)相比,控制性肺萎陷(萎陷程度90%和50%)能更好地减轻术中肺损伤,但萎陷程度90%与50%之间未见明显差异。
Objective Using a new type of pulmonary isolation ventilation tool to investigate the correlation be- tween the controlled pulmonary collapse and the early lung injury in dogs. Methods Eighteen dogs were randomly and e- qually divided into 3 groups （ G1 - （13）. A new single - lumen endotracheal tube was intubated after general anesthesia. Two lung ventilation （TLV） was performed for 20min, and the left one - lung ventilation （OLV） was subsequently carried out with the right lung collapse at 100% （ G1 ） , 90% （ G2 ） , and 50% （ G3 ）. Blood samples were taken from the femoral artery and jugular vein before OLV （T0） , and 30min （T1）, 60min （T2） and 120min （T3） after OLV. The blood gas a- nalysis was performed assessment of pulmonary shunt rate （QS/Qt）. ELISA was applied assessment of serum TNF - α and IL -6. The blood pressure, heart rate, pulmonary artery pressure and et al. were continuously monitored during opera- tion. Lung tissues were collected at T3 to determine the wet/dry weight ratio （ W/D）. The histopathological changes of the lung tissues were observed by microscopy and performed by blind scoring. Results During TLV, there was no significant difference in all physiological indexes among all 3 groups （ P 〉 0. 05 ）. During OLV, the mean pulmonary arterial pres- sures （MPAP） in G2 and G3 were significantly more stable than that in G1 （P 〈 0. 05 ）. The QS/Qt, W/D, TNF -α and IL - 6 contents in G2 and G3 were significantly lower than those in the G1 （ P 〈 0. 05 ）. The pulmonary edema, hemorrhage, inflammatory cell infiltration and lung injury scores were also reduced. There was no significant difference between G2 and G3 at each time point （ P 〉 0. 05 ）. Conclusion Compared with complete pulmonary collapse （ 100% ） , controlled pulmonary collapse （90% and 50% collapse） by using the new single - lumen isolation endotracheal tube can alleviate the intraoperative lung injury. There is no significant difference between 90% and
作者
严笑
唐建军
马显峰
肖鸣
杨雪莹
卢薪
刘高望
刘晓军
古妙宁
肖金仿
YAN Xiao TANG Jian -jun MA Xian -feng XIAO Ming YANG Xue - ying LU Xin LIU Gao - wang LIU Xiao -jun GU Miao - ning XIAO Jin - fang(Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong , China)
出处
《广东医学》
CAS
北大核心
2017年第15期2271-2275,共5页
Guangdong Medical Journal
基金
广东省科技计划项目(编号:2016B090918111)
关键词
单肺通气
肺萎陷程度
肺损伤
one - lung ventilation
the degree of pulmonary collapse
lung injury
