肺动脉灌注低温肺保护液抑制肺组织细胞凋亡的研究

Research of Pulmonary Artery Perfusion with Hypothermic Lung-protective Solution Inhibits Apoptosis in Lung Tissue Cell

目的探讨体外循环(cardiopulmonary bypass,CPB)期间肺动脉灌注低温肺保护液对肺组织细胞凋亡的影响。方法将20例风湿性二尖瓣病变患者随机分为肺保护组和对照组,每组10例。2组患者均在CPB下行单纯二尖瓣人工机械瓣置换术。肺保护组CPB期间经肺动脉灌注低温肺保护液,对照组CPB期间经肺动脉灌注等量生理盐水。监测2组患者CPB术后0、6、122、4 h呼吸功能,取动脉血1 mL进行血气分析,计算氧合指数。同时于CPB术前及停止CPB术后分别取2组患者右下肺组织(1.0 cm×1.0 cm×1.0 cm)活检标本,原位DNA末端标记法(TUNEL法)检测肺组织细胞凋亡情况。结果肺保护组CPB术后0、6、12、24 h氧合指数均高于对照组(P<0.01或P<0.05)。2组CPB术后肺组织细胞凋亡率均较CPB术前明显增多(P均<0.01)。肺保护组、对照组CPB术后肺组织细胞凋亡率分别为(10.46±1.96)%、(18.68±1.34)%,2组比较差异有统计学意义(P<0.01)。结论(1)常规低温CPB术可以诱导肺组织细胞的细胞凋亡。(2)CPB期间经肺动脉灌注低温肺保护液可显著抑制肺组织细胞的凋亡,减轻CPB肺损伤,提示其具有肺保护作用。

Objective To explore effects of pulmonary artery perfusion with hypothermic lungprotective solution on the apoptosis of lung tissue cells during cardiopulmonary bypass（CPB）. Methods Twenty cases undergoing mitral valve replacement（MVR） were randomly divided into lung protective group and control group with 10 cases in each group. The patients were replaced mechanical mitral valve under CPB. Hypothermic lung-protective solution was infused to the main pulmonary artery in the lung protective group,and sodium chloride was infused to the main pulmonary artery in the control group. Lung biopsy specimens（1.0 cm× 1.0 cm× 1.0 cm） were obtained before and after CPB in order to study the apoptosis of lung tissue cells using terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling（TUNEL）. At same time, 1 mL artery blood was taken for blood gas analysis. Patients＇ lung functions and calculation oxygenation index were monitored after CPB 0,6,12,24 h. Results The oxygenation index was higher in the lungprotective group than that in the control group at 0,6,12,24 h after CPB（P〈 0.01 or P〈0.05）. In sitau Tunnel staining showed that after CPB, the number of apoptosis cell in lung protective group and control group increased significant P〈0.01）. After CPB,the rate of apoptosis ce y compared with those of before CPB of both（all ls of lung tissue cells was （18.68±1.34）% in control group,whereas （10.46 ±1.96）% in lung protective group. There was significant difference between two groups（P〈0.01）. Conclusion （1）Conventional hypothermic CPB induces apoptosis in lung tissue cells. （2）Pulmonary artery perfusion with hypothermic lung-protective solution can inhibit the apoptosis of lung tissue cells and relieve CPB induced lung injury, demonstrates the effects of lung protection.