热缺血期通气对大鼠无心跳供肺的作用

Effect of Ventilation during Warm Ischemia Time on Non-Heart-Beating-Donor in Rat Lung Transplantation

目的:探讨大鼠肺移植手术中,心脏停跳后热缺血期通气对大鼠无心跳供肺的影响。方法:雄性Sprague-Dawley(SD)大鼠64只,按供体鼠体质量稍轻于受体鼠的原则,将其随机配成32对。将32对大鼠随机分为热缺血3h不通气组(warm is-chemia with non-ventilation,WNV组)和热缺血3h并机械通气3h组(warm ischemia with ventilation,WV组)2组,每组16对;每组大鼠根据再灌注时间,分为再灌注2h亚组和再灌注24h亚组,每亚组8对。建立大鼠无心跳供肺移植模型,再灌注2h或24h后对移植肺进行血气分析并处死大鼠,取其肺组织,检测肺湿干质量比、肺损伤病理评分、细胞凋亡等指标并在电镜下观察细胞超微结构。结果:左肺静脉的氧分压(PaO2)在WNV组和WV组的2个再灌注2h亚组之间以及2个再灌注24h亚组之间均有显著差异(P<0.05),右颈动脉PaO2仅在2个再灌注24h亚组之间有显著差异(P<0.05);左肺湿干质量比和光镜形态学病理损伤评分在2个再灌注24h亚组之间均有显著差异(P<0.05);细胞凋亡指数在2个再灌注2h亚组之间有显著差异(P<0.05);电镜观察显示WV组细胞超微结构的损伤较WNV组轻。结论:热缺血期通气能够改善大鼠无心跳供肺移植缺血再灌注肺损伤,提示无心跳供肺热缺血时间在低温且肝素化通气状况下可达3h。

Objective：To investigate the effect of ventilation during warm ischemia time（WIT） on non-heart-beating-donor（NHBD） in rat lung transplantation.Methods：A total of 64 male Sprague-Dawley rats were randomized into either WV（warm ischemia with ventilation） group or WNV（warm ischemia with non-ventilation） group.Rats in WV group were ventilated during 3 h WIT and rats in WNV group were not ventilated during 3 h WIT.Each group was further divided into two subgroups： 2 h subgroup and 24 h subgroup（8 pairs for each subgroup）.All rats were under topical cooling with cold sodium chloride solutions.Rat NHBD lung transplantation models have been established,and rats in 2 h subgroup and 24 h subgroup were sacrificed after a reperfusion of 2 h and 24 h,respectively.Blood gas,wet-to-dry weight ratio（W/D）,lung injury score,apoptosis index（AI） and electronmicroscopic ultrastructure were detected in the transplanted lungs.Results： The PaO2 of the left pulmonary vein showed significant difference between the two 2 h subgroups,as well as the two 24 h subgroups of the two groups（P〈0.05）.The PaO2 of the right cervical artery showed significant difference between the two 24 h subgroups of the two groups（P〈0.05）.The W/D ratios and the lung injury scores in the transplanted lungs showed significant difference between the two 24 h subgroups of the two groups（P〈0.05）.The AI showed significant difference between the two 2 h subgroups of the two groups（P〈0.05）.Injuries in electronmicroscopic ultrastructures were less in WV group than in WNV group.Conclusions： Ventilation during WIT may ameliorate ischemia-reperfusion injury in rat NHBD and WIT in NHBD can last 3 h with ventilation under heparinization and topical cooling.