【關鍵詞】體外循環
Effect of hypothermic ventricular fibrillation on lung function in dogs undergoing cardiopulmonary bypass
【Abstract】 AIM: To evaluate the effect of hypothermic ventricular fibrillation on lung function in dogs undergoing cardiopulmonary bypass（CPB）. METHODS: Fourteen healthy adult dogs were randomly divided into 2 groups (n=7 per group): hypothermic fibrillation group (experimental group) and cold crystalloid cardioplegia group (control group). Operation was performed through the fourth right intercostal space under general anesthesia, which was followed by systemic hypothermia to 28℃. A standard CPB was performed in the control group. Ventricular fibrillation was induced by injecting 4℃normal saline into pericardial cavity. The concentration of serum IL8 was measured by ELISA before CPB, at the 1st hour during CPB, at the end of CPB and at the 1st hour after CPB. Lung specimens were obtained before CPB and at the end of CPB. Lung compliance was used to evaluate lung function. RESULTS: The concentration of serum IL8 in the 2 groups was significantly different（P<0.05）, so was it at various time points （P<0.05）. No difference was found in the 2 groups before CPB. The serum IL8 level went up gradually after the initiation of CPB and reached its peak at the end of CPB. IL8 level decreased at the 1st hour after CPB, but it was still higher than that before CPB. Compared with that in the control group, the histopathological lesion in lungs was less severe in the experimental group. No statistical difference of lung compliance was found between the experimental and control groups before CPB, but significant difference was found at various time points between the two groups（P<0.05） after CPB. The lung compliance went down gradually after the initiation of CPB and reached the lowest point by the end of CPB. CONCLUSION: Compared with normal CPB, hypothermic ventricular fibrillation under cardiopulmonary bypass reduces the lesion of tissues and has some protective effects on lung function.
【Keywords】 CPB; lung injury; lung compliance; serum IL8; hypothermic ventricular fibrillation
【摘要】 目的：探討體外循環低溫室顫對犬肺功能的 影響 . 方法 ：健康成年雜種犬14隻隨機分為實驗組和對照組,每組7隻. 全麻，右側第四肋間進胸，常規建立體外循環（CPB），心尖部左心引流. 實驗組：不阻斷升主動脈，血流降溫到28℃,心包腔內注入4℃生理鹽水誘導室顫；對照組：阻斷升主動脈，經主動脈根部灌注停跳液. 檢測不同時間點血清IL8濃度、肺順應性，觀察肺組織形態學改變，比較體外循環條件下低溫室顫對肺臟的損傷程度. 結果：實驗組與對照組的血清IL8的濃度水平比較差異有統計學意義（P<0.05），各時間點之間也存在差異（P<0.05）. 兩組在T1時間點的IL8濃度無明顯差別，轉機後均開始升高，且均在T3時間點達到高峰，並於T4時間點逐漸下降，但仍然高於T1時間點水平. 肺組織形態學顯示：實驗組較對照組肺組織病理損傷減輕；肺順應性：實驗組與對照組肺順應性比較差異有統計學意義（P<0.05），各時間點之間也存在差異（P<0.05）. 兩組在T1時間點肺順應性無明顯差別，轉機後均開始降低，且均在T3時間點達到高峰，並於T4時間點逐漸恢復，但仍然低於T1時間點水平. 結論：體外循環中 應用 低溫室顫技術可降低組織的損傷程度,對肺功能有保護作用.
【關鍵詞】 體外循環；肺損傷；肺順應性；血清白介素8；低溫室顫
0引言
體外循環(cardiopulmonary bypass,CPB)是心臟外科領域的一項重要技術, 常規CPB心臟停搏導致肺損傷已有較多報道，但在體外循環中採用低溫室顫保護肺功能少見報道. 本 研究 旨在探討體外循環低溫室顫對肺功能的影響，為臨床應用提供 理論 依據.
1材料和方法
1.1材料
血清IL8 ELISA試劑盒購自北京華美生物工程公司. 匯康1000型心肺機（天津醫療器械廠）， 氧合器（西京醫療器械廠），惠普M1165A監護儀（德國西門子公司）,940呼吸生理儀（芬蘭DATEX公司）. 14隻健康成年雜種犬，體質量（30±5）kg,雌雄不限. 隨機分為2組,每組7隻:實驗組: 低溫體外循環不阻斷升主動脈室顫左室引流組；對照組: 低溫體外循環阻斷升主動脈常規停跳組.
1.2方法
全麻、氣管插管，呼吸機控制呼吸. 經左側股動、靜脈插入動脈測壓管及靜脈輸液管. 監測標準肢體導聯心電圖，留置尿管，溫度探頭測鼻溫、肛溫. 右側第四肋間進胸，切開心包，暴露心臟，常規建立體外循環. 心尖部插左室引流管，並行循環血流降溫，鼻咽溫度降至28℃. 對照組：阻斷升主動脈和上、下腔靜脈，主動脈根部灌注冷血高鉀停跳液，心臟停搏，維持120 min，復溫，開放升主動脈，恢復自主心跳. 實驗組：不阻斷升主動脈，保持主動脈壓力10.66 kPa. 並行循環，血流降溫及心包腔內注入4℃生理鹽水，維持鼻咽溫度28℃，低溫誘導室顫，維持室顫120 min，復溫後恢復自主心跳. 分別在CPB前（T1），CPB 1 h（T2），CPB結束即刻（T3），CPB結束後1 h（T4）取犬血清及肺組織並記錄肺功能指標.
統計學處理：數據以x±s表示，使用SAS6.0軟體進行重複測量方差 分析 . P<0.05認為差異有統計學意義.
收藏