肺缺血预处理在深低温停循环中肺保护的实验【临床专业医学论文设计】.doc

《肺缺血预处理在深低温停循环中肺保护的实验【临床专业医学论文设计】.doc》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。

1、临床医学论文•肺缺血预处理在深低温停循环中肺保护的实验【摘要】目的评估肺缺血预处理(ischemicprccondifioning,IP)在深低温停循坏(deephypothermiccirculatoryarrest，DHCA)心夕卜科手术中对肺功能的保护作用。方法幼猪在体DHCA实验模型，分常温再灌注组(基线组)、无肺IP的DHCA组(对照组)和有肺IP的DHCA组(IP组)测体外循环(extracorporealcirculation,ECOmi、结束即刻和结束后lh肺静态顺应性和肺血管阻力値；以左房血和肺动脉血中相关炎性介质浓度和白细胞黏

2、附分子受体表达値的比値(LA/PA)，反应肺区释放量和激活量；ECC结束即刻取肺组织行光、电镜观察。结果三组ECC后，肺静态顺应性均显著降低，肺血管阻力均显著增加，IP组较对照组有显著差异，显示了明显的肺保护作用。三组ECC后，肿瘤坏死因子(TNF)-a、白介素(IL)-l0的LA/PA比値均显著增加，而IL・8比値仅在对照组和IP组明显增加；INF-a比値IP组较其他两组无显著差异；IL-8、IL-10比値，IP组较对照组均显著降低；中性粒细胞CD18表达比値，仅在对照组ECC后1h相对于ECC前显著降低；单核细胞CD18表达比値，对照组较基线

3、组显著降低。光镜和电镜下的肺损伤程度IP组较对照组明显减轻。结论本硏究示DHCA加剧ECC肺区炎性反应，证实了肺TP可以减轻DHCA情况下缺血再灌注引起的炎性反应性肺损伤，从而保护肺功能。【关键词】体外循环深低温停循环肺缺血预处理缺血再灌注损伤Abstract:OBJECTIVEToevaluatetheprotectiveeffectofusinglungischemicpreconditioning(IP)priortocardiacsurgerywithdeephypothermiccirculatoryarrest(DHCA)extrac

4、orporealcirculation(ECC).METHODSUsingananimalmodelofDHCAECC»pigletsweredividedrandomlyintothreegroups:normothermicECCreperfusiongroup(baselinegroup),DHCAgroupwithoutlungIP(controlgroup)andDHCAgroupwithlungIP(IPgroup)・Lungsialiccomplianceandpulmonaryvascularresistanceweremeasu

5、redatthebeginningandendofECCandonehourlater.Bloodwassimultaneouslydrawnfromtheleftatrium(LA)andthepulmonaryartery(PA)，thelevelofTNF・a、IL・8andIL-10weredetermined，aswc11astheadhesionmoleculesCD18onleukocytes.Asameasureofthepulmonaryrelease，ratiosofLA/PAlevelswerecalculated・Apie

6、ceoflungtissuewastakenattheendofECCtoevaluatemorphologyby1ightandelectronmicroscopy.RESULTSAfterECClungstaticcompliancewassignificantlydecreasedwhereaspulmonaryvascularresistancewassignificantlyincreased‘IPgroupshowedthesignificantprotectiveeffect.AfterECCLA/PAratiosforTNF-a,

7、IL-10weresignificantlyincreasedineachgroups，whereastheratiosforIL・8weresignificantlyincreasedonlyincontrolandTPgroups,LA/PAratiosforTNF・ahadnosignificantdifferencebetweenIPgroupandtheothertwogroups；LA/PAratiosforIL・8inIPgroupweresignificantlydecreasedcomparedwithcontrolgroup,

8、LA/PAratiosforIL-10bothincontrolgroupandIPgroupweresignificantlyincr