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论著:热缺血期通气对大鼠无心跳供肺的作用
Effect of Ventilation during Warm Ischemia Time on Non Heart Beating Donor in Rat Lung Transplantation
郭卫刚 谭黎杰 王群 薛亮 徐松涛
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作者单位:复旦大学附属中山医院胸外科
中文关键字:肺移植;无心跳供肺;缺血再灌注损伤;通气;热缺血时间
英文关键字:Lung transplantation;Non heart beating donor;Ischemia reperfusion injury;Ventilation;Warm ischemia time
中文摘要:目的:探讨大鼠肺移植手术中,心脏停跳后热缺血期通气对大鼠无心跳供肺的影响。
方法:雄性Sprague Dawley(SD)大鼠64只,按供体鼠体质量稍轻于受体鼠的原则,将其随机配成32对。将32对大鼠随机分为热缺血3 h不通气组(warm ischemia with non ventilation, WNV组)和热缺血3 h并机械通气3 h组(warm ischemia with ventilation, WV组)2组,每组16对;每组大鼠根据再灌注时间,分为再灌注2 h亚组和再灌注24 h亚组,每亚组8对。建立大鼠无心跳供肺移植模型,再灌注2 h或24 h后对移植肺进行血气分析并处死大鼠,取其肺组织,检测肺湿干质量比、肺损伤病理评分、细胞凋亡等指标并在电镜下观察细胞超微结构。结果:左肺静脉的氧分压(PaO2)在WNV组和WV组的2个再灌注2 h亚组之间以及2个再灌注24 h亚组之间均有显著差异(P<0.05),右颈动脉PaO2仅在2个再灌注24 h亚组之间有显著差异(P<0.05);左肺湿干质量比和光镜形态学病理损伤评分在2个再灌注24 h亚组之间均有显著差异(P<0.05);细胞凋亡指数在2个再灌注2 h亚组之间有显著差异(P<0.05);电镜观察显示WV组细胞超微结构的损伤较WNV组轻。结论:热缺血期通气能够改善大鼠无心跳供肺移植缺血再灌注肺损伤,提示无心跳供肺热缺血时间在低温且肝素化通气状况下可达3 h。
英文摘要:Objective:To investigate the effect of ventilation during warm ischemia time(WIT) on non heart beating donor(NHBD) in rat lung transplantation. Methods:A total of 64 male Sprague Dawley rats were randomized into either WV(warm ischemia with ventilation) group or WNV(warm ischemia with non ventilation) group. Rats in WV group were ventilated during 3 h WIT and rats in WNV group were not ventilated during 3 h WIT. Each group was further divided into two subgroups: 2 h subgroup and 24 h subgroup (8 pairs for each subgroup). All rats were under topical cooling with cold sodium chloride solutions. Rat NHBD lung transplantation models have been established, and rats in 2 h subgroup and 24 h subgroup were sacrificed after a reperfusion of 2 h and 24 h, respectively. Blood gas, wet to dry weight ratio(W/D), lung injury score, apoptosis index (AI) and electronmicroscopic ultrastructure were detected in the transplanted lungs.
 Results: The PaO2 of the left pulmonary vein showed significant difference between the two 2 h subgroups, as well as the two 24 h subgroups of the two groups(P<0.05). The PaO2 of the right cervical artery showed significant difference between the two 24 h subgroups of the two groups(P<0.05). The W/D ratios and the lung injury scores in the transplanted lungs showed significant difference between the two 24 h subgroups of the two groups(P<0.05). The AI showed significant difference between the two 2 h subgroups of the two groups(P<0.05). Injuries in electronmicroscopic ultrastructures were less in WV group than in WNV group.
 Conclusions: Ventilation during WIT may ameliorate ischemia reperfusion injury in rat NHBD and WIT in NHBD can last 3 h with ventilation under heparinization and topical cooling.
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