内科微创肺减容术对慢性阻塞性肺疾病新西兰兔肺功能的影响

Influence of internally microinvasive medical lung volume reduction surgery on the lung function of New Zealand rabbits with chronic obstructive pulmonary disease

目的:观察新西兰兔肺气肿经内科微创肺减容治疗前后血气分析结果和肺功能变化,探讨该手术的可行性、有效性和安全性。方法:实验于2004-09/2004-12在南京医科大学动物实验基地完成。20只雄性健康新西兰白兔随机分为2组,手术组和对照组,每组各10只,用气管内一次性注入胰弹性蛋白酶的方法复制肺气肿。手术组在X射线下插导管至右肺中下叶肺段,然后注入生物蛋白胶0.5mL,造成肺段不张;对照组按同样方法插管,注入0.5mL生理盐水作为对照。在造模前、造模后和手术后2周分别采用动物肺功能分析系统测定肺功能并进行血气分析,比较肺功能和血气的变化。结果:①手术组术后有1只动物死于肺部感染,其余动物饮食正常,体质量没有减轻,没有出现缺氧以及呼吸困难等体征。两组动物造模后形成中度肺气肿,肺功能和血气分析结果无明显差异(P>0.05)。②肺功能:手术组手术后功能残气量用力呼气时间、最大用力呼气中期时间、吸气气道阻力、呼气气道阻力、功能残气量明显低于或短于造模后(P<0.05～0.01);第0.4秒用力呼气量与用力肺活量的比值、第0.6秒用力呼气量与用力肺活量的比值、呼出50%用力肺活量时的流速、呼出75%用力肺活量时的流速、用力呼气峰值流速、最大呼气中期流速、动态肺顺应性明显高于造模后(P<0.05～0.01)。对照组第0.4秒用力呼气量与用力肺活量的比值、第0.6秒用力呼气量与用力肺活量的比值低于造模后(P<0.05),最大用力呼气中期时间明显长于造模后(P<0.05)。③血气分析:手术组手术后动脉血氧分压、氧饱和度、pH值明显高于造模后(P<0.05～0.01)。对照组手术后动脉血压氧分压明显低于造模后(P<0.05)。结论:肺气肿兔经内科微创肺减容治疗后,肺功能和血气分析有明显改善,且有较高安全性。

AIM:To observe changes of blood gas analysis and lung function in New Zealand rabbits with emphysema before and after internally medical lung volume reduction surgery, and investigate its feasibility, effectiveness and safety. METHODS: The experiment was completed in the animal experimental basement of Nanjing Medical University between September and December 2004. 20 male New Zealand white rabbits were randomized into surgery group (n=10) and control group (n=10). Animals were replicated to models of emphysema by injecting pancreatic elastase into trachea only once. In the surgery group, a micro-tube was catheterized into the middle or inferior lobe segments of right lung of all rabbits under X-ray, and then 0.5 mL fibrin glue was infused to induce segmental atelectasis. In the control group, catheterization was the same as that in the surgery group, 0.5 mL was infused as control.The lung function was detected and blood gas analysis was undertaken with animal pulmonary function analyzing system before and after model establishment and 2 weeks after surgery, and then the changes of lung function and blood gas were compared. RESULTS:① In the surgery group, 1 rabbit died from pulmonary infection, others had normal diet and no reduce of body bass, no physical signs of hypoxia and dysnoea were observed. Moderate emphysema developed after model establishment in both groups, and there were no obvious differences in lung function and blood gas analysis (P > 0.05).② Lung function: In the surgery group, functional residual capacity forced expiratory duration, maximal forced mid-expiratory duration, inspiratory airway resistance, expiratory airway resistance and functional residual capacity after surgery were obviously lower or shorter than those after model establishment (P < 0.05 to 0.01), The ratios of forced expiratory volume at 0.4 and 0.6 seconds to forced vital capacity, flow rates of 50% and 75% expiratory forced vital capacity, forced expiratory peak flow rate, maximal mid-expiratory flow and dynamic lung compliance after surgery were obviously higher than those after model establishment (P < 0.05 to 0.01). In the control group, the ratios of forced expiratory volume at 0.4 and 0.6 seconds to forced vital capacity after surgery were lower than those after model establishment (P < 0.05), the maximal forced mid-expiratory duration was obviously longer than that after model establishment (P < 0.05). ③ Blood gas analysis: In the surgery group, arterial partial pressure of oxygen, oxygen saturation and pH value after surgery were obviously higher than those after model establishment (P < 0.05 to 0.01); In the control group, arterial partial pressure of oxygen after surgery was obviously lower than that after model establishment (P < 0.05). CONCLUSION: After microinvasive internally medical lung volume reduction surgery, the lung function and blood gas analysis of rabbits with emphysema are obviously ameliorated, and it has higher safety.