控制性再灌注防止肺再灌注损伤的研究

Controlled reperfusion preventing pulmonary reperfusion injury

目的 探讨控制性再灌注在预防肺缺血再灌注 (I/R)损伤中的作用及其机制。方法将猪分为 2组 ,10只猪切取左肺作供体 ,4℃改良的E C液灌洗和保存 ,4h后进行左肺移植。对照组常规操作 ,实验组采用控制性再灌注 :灌注液 (去白细胞血 :改良Buckberg液 =4∶1) ;灌注压 2 0mmHg ;灌注时间 10min。 0 .5、1和 2h后测血氧分压、肺血管阻力、肺顺应性、一氧化氮 (NO)含量、丙二醛 (MDA)含量、肺干 /湿重比。结果 实验组的左肺氧合功能 ,肺顺应性明显好于对照组 ,肺循环阻力、MDA值及肺含水量均低于对照组 (P <0 .0 1) ;实验组肺中NO含量较对照组明显升高 (P <0 .0 1)。结论 控制性再灌注能明显降低肺I/R损伤 ,起到了较好的移植肺保护效果。

Objective To study the controlled reperfusion in the lung reperfusion injury and possible mechanism.Methods Twenty pigs were divided into 2 groups.The left lungs in 10 pigs were flushed with a modified Euro Collins solution and stored at 4 ℃ for 4 h,and transplanted into 10 other pigs.Five pigs (group Ⅰ) underwent uncontrolled reperfusion by removal of the vascular clamps after transplantation and the remaining 5 pigs (group Ⅱ) underwent controlled reperfusion: perfusion solution,leukocyte depleting blood:modified Buckberg solution=4:1; perfusion pressure,20 mmHg; perfusion time,10 min.Functions of the left lung were assessed at 0.5,1 and 2 h after transplantation.Results The functions of lung in group Ⅱ was significantly better than in the group I ( P <0.01).Controlled reperfusion (group Ⅱ) minimized the reperfusion injury,increased NO (112.3±7.31 versus 57.63± 6.37 μmol/L, P <0.01),and lowered MDA (18.27±1.79 versus 23.71±2.37 nmol/mg prot, P < 0.01) and tissue edema (82.6±0.1 versus 85.7±0.3, P <0.01).Conclusion Controlled reperfusion can significantly attenuate pulmonary reperfusion injury and have a protective effect on the lung.