肺动脉灌注低温肺保护液抑制肺内实质细胞凋亡的研究

Pulmonary artery perfusion with hypothermic solution inhibits the apoptosis of lung parenchymal cells during cardiopulmonary bypass

目的 探讨体外循环中肺动脉灌注低温保护液对肺内实质细胞凋亡的影响。方法 将4 0例行法洛四联症根治术的患儿分为肺保护组和对照组 (各 2 0例 )。肺保护组体外循环期间肺动脉灌注低温肺保护液 ,对照组行常规法洛四联症根治术。 2 0例患儿 (两组各 10例 )术后取右下肺组织活检标本 ,原位末端标记免疫组化染色法检测肺内实质细胞凋亡情况。同时监测围手术期肺功能及临床指标。结果 肺保护组肺内实质细胞凋亡率为 (10± 2 ) % ,而对照组肺内实质细胞凋亡率为 (18± 7) % ,两者比较 ,差异有显著性 (t=- 2 95 ,P <0 0 5 )。肺保护组术后氧指数较对照组高 ,回ICU病房后 0、6和 12h均有显著差异 [分别为 (4 92± 172 )、(4 4 4± 10 4 )、(4 89± 5 8)mmHg和 (36 9± 12 6 )、(347± 10 7)、(340± 119)mmHg ,t =2 5 9,P <0 0 5 ;t=2 88,P <0 0 1;t =5 0 6 ,P <0 0 1];肺保护组呼吸机辅助通气时间短于对照组 [(15± 11)h和 (2 6± 15 )h ,t=- 2 76 ,P <0 0 1]。结论 肺动脉灌注低温保护液可抑制肺组织内实质细胞凋亡 。

Objective To study effects of pulmonary artery perfusion with hypothermic solution on the apoptosis of lung parenchymal cells during cardiopulmonary bypass Methods Forty children with tetralogy of Fallot were divided into control group ( n =20) and protective group ( n =20) The patients in control group were performed using routine approaches Patients' pulmonary artery were infused with 4℃ protective solution during cardiopulmonary bypass in protective group Lung biopsy specimens were obtained after operations in order to study the apoptosis of lung parenchymal cells using tunnel techniques At same time,patients' pulmonary functions and clinic index were monitored Results The rate of apoptosis cells of lung parenchymal cells was (18±7)% in control group,whereas (10±2)% in protective group There was significant difference between both groups ( t =-2 95, P <0 05) Index O 2 in protective group was higher than that in control group at 0,6 and 12 hours after operations [(492±172),(444±104),(489±58)mm Hg versus (369±126),(347±107),(340±119)mm Hg, t =2 59, P <0 05; t = 2 88, P <0 01; t =5 06, P <0 01,respectively)] The time of mechanical ventilation was significantly shorter in protective group than in control group [(15±11)hours versus (26±15)hours, t =-2 76, P <0 01] Conclusion Pulmonary artery perfusion with hypothermic solution can inhibit the apoptosis of lung parenchymal cells and relieve cardiopulmonary bypass induced lung injury