肺动脉和支气管动脉双循环冲洗在供肺保存中的作用

Effect of simultaneous pulmonary artery and bronchial artery flushing in lung preservation

目的:探讨肺动脉和支气管动脉双循环冲洗在供肺保存中的作用。方法:12只健康新西兰白兔随机分为2组:对照组(肺动脉冲洗组)和实验组(肺动脉和支气管动脉双循环冲洗组),每组6只。供肺经过24h保存后采用离体肺循环灌流模型再灌流60min。灌流中观察2组肺动静脉血氧分压差(ΔpO2)、二氧化碳分压差(ΔpCO2)、肺动脉压(pPA)、气道压(pAW)、静态肺顺应性(Cstat)的变化和2组保存末、灌流末肺组织和灌流末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)的变化。比较2组间肺质量湿干比(W/D)。结果:实验组灌流中△pO2、△pCO2、Cstat明显高于对照组,pPA、pAW明显低于对照组,保存末、灌流末肺组织和灌流末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:肺动脉和支气管动脉双循环冲洗能保护肺表面活性物质磷脂,从而改善供肺保存和再灌注后的肺功能。

Aim ： To explore the effect of simultaneous pulmonary artery and bronchial artery flushing in lung preservation. Methods： Twelve rabbits were allocated into two groups at random： control group（ pulmonary artery flushing）and experimental group（ pulmonary artery and bronchial artery flushing）. After 24 h preservation, lungs were perfused for 60 rain with an isolated lung circulation and perfusion model. The difference of blood po2 between pulmonary artery and vein （ △po2 ） ,the difference of blood pco2 between pulmonary artery and vein（ △pco2 ） ,pulmonary artery pressure（pPA ） ,pressure of airway （pAW）, static compliance （Cstat）, lung wet-to-dry weight ratio（ W/D ）, total phosphalipid （TPL）, phosphatidylcholine（PC） , PC to TPL ratio（PC/TPL） , lecithin-to-sphingomyelin ratio（L/S） were studied. Results： Compared with control group, there was significant elevation of △po2, △pco2, Cstat, and reduction of pPA, pAW and W/D in experimental group. TPL, PC, PC/TPL,L/S in lung tissue and BALF after preservation and reperfusion in experimental group were higher than those in control group. Conclusion： Simultaneous pulmonary and bronchial artery flushing preserves surfactant system well and improves lung function after preservation.