体外循环中肺动脉灌注改良低钾右旋糖酐液对兔肺保护作用的研究

Study on the protective effect of pulmonary artery perfusion with improved low-potassium dextran solution supplemented by glutathione on the rabbits lungs during cardiopulmonary bypass

目的:建立体外循环(CPB)期间肺动脉灌注动物模型,观察肺动脉灌注添加谷胱甘肽的改良低钾右旋糖酐液(LPD液)对CPB所致肺损伤的预防作用。方法:健康杂种家兔20只,随机分为2组(n=10):对照组(CPB无肺动脉灌注)和灌注组(CPB改良LPD液肺动脉灌注)。于CPB不同时点分别抽取血样检测肿瘤坏死因子-α(TNF-α)和动脉血气,计算氧合指数(PO2/FiO2);停CPB后取肺组织测定丙二醛(MDA)和计算肺湿干比(W/D)。结果:随着CPB的进行,两组PO2/FiO2均呈下降趋势,而CPB 90 min时灌注组PO2/FiO2明显高于对照组(298±40vs252±51,P<0.05);CPB开始后两组TNF-α水平呈上升趋势,而对照组上升更明显,在CPB 60 min和CPB 90 min对照组水平明显高于灌注组[(44.63±8.07)pg.ml-1vs(37.96±5.78)pg.ml-1、(51.35±6.79)pg.ml-1vs(44.93±6.63)pg.ml-1,P<0.05];停CPB后,灌注组肺组织MDA和肺组织W/D低于对照组。结论:CPB期间经肺动脉灌注改良LPD液能减轻CPB所造成的肺损伤,改善肺功能。

Objective： To establish the experimental model of pulmonary artery perfusion during cardiopulmonary bypass（CPB） and to observe the protective effect of pulmonary artery perfusion with improved low-potassium dextran solution（LPD solution） supplemented by glutathione（GSH） on lung during CPB.Methods： Twenty rabbits were randomly divided into two groups： control group（no pulmonary artery perfusion during CPB）and perfusion group（pulmonary artery perfusion with LPD solution during CPB）.Blood samples were drawn at different time points during CPB for tumor necrosis factor-α（TNF-α） and blood gas analysis,and oxygenation index was calculated;Malondialdehyde（MDA） and wet-to-dry ratio（W/D） of lung at the end of CPB were measured and calculated.Results： With the CPB,the oxygenation index of perfusion group and control group were both decreased,however the oxygenation index of perfusion group was significantly higher than that of control group after 90 minutes of CPB（298±40 vs 252±51,P0.05）,After the CPB,the levels of TNF-α in two groups rised,while the level of TNF-α in control group was more obviously increased,the level of TNF-α in control group was higher than that in perfusion group after 60 minutes of CPB[（44.63±8.07）pg·ml-1 vs（37.96±5.78）pg·ml-1,P0.05];and the level of TNF-α in control group was significantly higher than that in perfusion group after 90 minutes of CPB[（51.35±6.79）pg·ml-1 vs（44.93±6.63）pg·ml-1,P0.05];Lung level of MDA and lung W/D in perfusion group were lower than those in control group at the end of CPB.Conclusion： Pulmonary artery perfusion with LPD solution supplemented by GSH during CPB can ameliorate lung function and attenuate lung injury caused by CPB.