外源性表面活性物质补充在供肺保存中的作用

The effect of exogenous surfactant supplement during lung preservation

目的:探讨外源性表面活性物质补充治疗在供肺保存中的作用。方法:12只实验动物兔随机分为对照组和实验组。实验组在供肺保存16h时经支气管注入外源性表面活性物质。供肺经24h保存后采用离体肺循环灌流模型再灌流60min。灌流中观察肺动静脉血氧分压差(ΔPO2)、二氧化碳分压差(ΔPCO2)、肺动脉压(PAP)、气道压(PAW)、静态肺顺应性(Cstat)的变化。对灌流末肺组织和支气管肺泡灌洗液中的总磷脂(TPL)、卵磷脂(PC)、卵磷脂/总磷脂(PC/TPL)、卵磷脂/鞘磷脂(L/S)进行分析,并比较两组间肺重湿干比(W/D)。结果:实验组灌流中ΔPO2、ΔPCO2明显高于对照组,PAP、PAW明显低于对照组。灌流末肺组织和支气管肺泡灌洗液中的TPL、PC、PC/TPL、L/S均明显高于对照组。W/D明显低于对照组。结论:供肺保存期间补充外源性表面活性物质可以改善供肺保存和再灌注后的肺功能。

Objective: To explore the effect of exogenous surfactant supplement during lung preservation. Methods:12 rabbits were evenly divided at random into control group and experimental group. Donor lungs of experimental group were administered exogenous surfactant through bronchus during lung preservation, while control group not. After 24 hours preservation, lungs were perfused for 60 minutes with an ex vivo isolated and circulated perfused lung model. The difference of blood PO2 between pulmonary artery and pulmonary vein(ΔPO2),the difference of blood PCO2 between pulmonary artery and pulmonary vein(ΔPCO2),pulmonary artery pressure(PAP),pressure of Airway(PAW),static compliance(Cstat),wet-to-dry ratio(W/D),total phospholipids(TPL), phosphatidylcholine(PC), pC/TPL, Lecithin-to-Sphingomyelin ratio(L/S) were studied. Results: Contrasting to the control group, there was significant elevation of ΔPO2, ΔPCO2 and reduction of PAP, PAW and W/D in experimental group. TPL, PC, PL/TPL,L/S of lung tissues and BALF after reperfusion in experimental group were higher than that in control group. Conclusion: Exogenous surfactant supplement during preservation can improve lung function in reperfusion.For the reason of metabolism and reperfusion injury to surfactant, exogenous surfactant should be administered intermittently or continuously during preservation and reperfusion.