全氟化碳對體外循環肺損傷保護的實驗研究_《中國胸心血管外科臨床雜志》

作者：

謝業偉 , 鄭景浩 , 徐志偉等

上海交通大學醫學院新華醫院上海兒童醫學中心心胸外科, 上海? 200127;

關鍵詞：

全氟化碳部分液體通氣急性肺損傷肺動脈持續灌注體外循環

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目的探討以全氟化碳(perfluorocarbon, PFC)為媒介的部分液體通氣(partial liquid ventilation,PLV)結合持續肺動脈灌注(continuous pulmonary perfusion, CPP)對體外循環(cardiopulmonary bypass, CPB)后幼豬急性肺損傷(acute lung injury,ALI)的肺組織炎性變化及氣體交換的影響。方法將18只幼豬(體重為10.2±1.6kg)隨機分為3組，對照組即單純CPB組：只行單純CPB; CPP+CPB組(CPP組):在主動脈阻斷期間,以20～25ml/kg·min的血液流量持續灌注肺動脈；PLV+CPP+CPB組(PLV組):在CPP組基礎上停CPB后即刻向肺內灌入12ml/kg的PFC。分別在CPB前、停CPB即刻及停CPB后1h、2h、3h觀察動脈血氣指標的變化;實驗結束后,取不同部位肺組織標本于光學顯微鏡下觀察組織病理的變化。結果與對照組比較，PLV組在1h、2h、3h時點動脈血氧分壓(PaO2)明顯升高，動脈-肺泡氧分壓梯度(AaDO2)明顯降低(P lt;0.05), 3h時動脈血二氧化碳分壓(PaCO2)下降顯著(P lt;005);CPP組的通氣、換氣功能也有明顯改善;PLV組保護作用則較為明顯。停CPB后，3組血液中的腫瘤壞死因子-α(TNF-α)、白細胞介素-8(IL-8)和白細胞介素-6(IL-6)均有所增加;與對照組比較，PLV組3h后TNF-α顯著降低(P lt;0.05)。組織學檢查:光學顯微鏡下見對照組肺組織(HE染色)細胞間黏附因子-1(ICAM-1)表達呈強陽性，PLV組及CPP組均呈弱陽性。結論以PFC為媒介的PLV結合持續肺動脈灌注介入CPB誘導的急性肺損傷,可明顯地降低肺組織炎癥反應和改善其肺氣體交換。

引用本文： 謝業偉,鄭景浩,徐志偉等. 全氟化碳對體外循環肺損傷保護的實驗研究. 中國胸心血管外科臨床雜志, 2007, 14(6): 438-. doi: 復制

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2.	Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002,21(2):232-244.
3.	Pintar T,Collard CD.The systemic inflammatory response to cardiopulmonary bypass. Anesthesiol Clin North America,2003, 21(3):453-464.
4.	Zobel G, Rdl S, Urlesberger B, et al. Partial liquid ventilation combined with two different gas ventilatory strategies in acute lung injury in piglets: Effects on gas exchange, respiratory mechanics, and hemodynamics. J Pediatr Surg, 2003, 38(4):527-533.
5.	Cheifetz IM,Cannon ML,Craig DM, et al. Liquid ventilation improves pulmonary function and cardiac output in a neonatal swine model of cardiopulmonary bypass. J Thorac Cardiovascular Surg,1998,115(3):528-535.
6.	Davies MW, Sargent PH. Partial liquid ventilation for the prevention of mortality and morbidity in paediatric acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev, 2004,2:CD003845.
7.	Nugent LJ, Mazzoni MC, Flaim SF, et al.Dose maintenance for partial liquid ventilation: passive heat-and-moisture exchanges. Biomed Instrum Technol, 1999, 33 (4) :365-372.
8.	Nakamura T, Tamura M.Partial liquid ventilation with low dose of perflubron and a low stretch ventilation strategy improves oxygenation in a rabbit model of surfactant depletion. Biol Neonate, 2002, 82(1):66-69.
9.	Thome UH,Schulze A,Schnabel R, et al. Partial liquid ventilation in severely surfactant-depleted,spontaneously breathing rabbits supported by proportional assist ventilation. Crit Care Med, 2001,29(6):1175-1180.
10.	Huang H, Yao T, Wang W, et al.Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery. Chin Med J (Engl), 2003, 116(10):1504-1507.
11.	Abraham E.Neutrophils and acute lung injury.Crit Care Med, 2003,31(4 Suppl):S195-S199.
12.	Jensen E, Bengtsson A,Berggren H, et al.Clinical variables and pro-inflammatory activation in paediatric heart surgery. Scand Cardiovasc J, 2001,35(3):201-206.
13.	Asimakopoulos G, Smith PL, Ratnatunga CP,et al. Lung injury andacute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg,1999,68 (3) :1107-1115.
14.	Haeberle HA, Nesti F, Diet rich HJ, et al.Perflubron reduces lung inflammation in respiratory syncytial virus infection by inhibiting chemokine expression and nuclear factor-kappa B activation.Am J Respir Crit Care Med, 2002,165(10):1433-1438.
15.	Koch T, Ragaller M, Haufe D, et al. Perfluorohexane attenuates proinflammatory and procoagulatory response of activated monocytes and alveolar macrophages. Anesthesiology,2001, 94(1):101-109.
16.	Schroeder S, Brger N, Wrigge H, et al. A tumor necrosis factor gene polymorphism influences the inflammatory response after cardiac operation. Ann Thorac Surg, 2003,75(2):534-537.
17.	Decleva E, Dri P, Menegazzi R, et al. Evidence that TNF-induced respiratory burst of adherent PMN is mediated by integrin alpha(L) beta (2).J Leukoc Biol, 2002,72(4):718-726.
18.	Maianski NA, Roos D, Kuijpers TW. Tumor necrosis factor alpha induces a caspase independent death pathway in human neutrophils. Blood, 2003, 101(5):1987-1995.
19.	Hill GE, Whitten CW, Landers DF. The influence of cardiopulmonary bypass on cytokines and cell-cell commu-nication. J Cardiothorac Vasc Anesth, 1997,11(3):367-375.
20.	Zheng JH, Xu ZW, Wang W, et al. Lung perfusion with oxygenated blood during aortic clamping prevents lung injury. Asian Cardiovasc Thorac Ann, 2004,12(1):58-60.
21.	Liu Y, Wang Q, Zhu X, et al. Pulmonary artery perfusion with protective solution reduces lung injury after cardiopulmonary bypass.Ann Thorac Surg, 2000, 69(5):1402-1407.
22.	von der Hardt K, Schoof E,Kandler MA,et al. Aerosolized perfluorocarbon suppresses early pulmonary inflasmmatory response in a surfactant-depleted piglet model.Pediatrc Res,2002,51(2):177-182.

1. 　Ng CS, Wan S, Yim AP,et al. Pulmonary dysfunction after cardiac surgery.Chest, 2002,121(4):1269-1277.
2. 　Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002,21(2):232-244.
3. 　Pintar T,Collard CD.The systemic inflammatory response to cardiopulmonary bypass. Anesthesiol Clin North America,2003, 21(3):453-464.
4. 　Zobel G, Rdl S, Urlesberger B, et al. Partial liquid ventilation combined with two different gas ventilatory strategies in acute lung injury in piglets: Effects on gas exchange, respiratory mechanics, and hemodynamics. J Pediatr Surg, 2003, 38(4):527-533.
5. 　Cheifetz IM,Cannon ML,Craig DM, et al. Liquid ventilation improves pulmonary function and cardiac output in a neonatal swine model of cardiopulmonary bypass. J Thorac Cardiovascular Surg,1998,115(3):528-535.
6. 　Davies MW, Sargent PH. Partial liquid ventilation for the prevention of mortality and morbidity in paediatric acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev, 2004,2:CD003845.
7. 　Nugent LJ, Mazzoni MC, Flaim SF, et al.Dose maintenance for partial liquid ventilation: passive heat-and-moisture exchanges. Biomed Instrum Technol, 1999, 33 (4) :365-372.
8. 　Nakamura T, Tamura M.Partial liquid ventilation with low dose of perflubron and a low stretch ventilation strategy improves oxygenation in a rabbit model of surfactant depletion. Biol Neonate, 2002, 82(1):66-69.
9. 　Thome UH,Schulze A,Schnabel R, et al. Partial liquid ventilation in severely surfactant-depleted,spontaneously breathing rabbits supported by proportional assist ventilation. Crit Care Med, 2001,29(6):1175-1180.
10. 　Huang H, Yao T, Wang W, et al.Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery. Chin Med J (Engl), 2003, 116(10):1504-1507.
11. 　Abraham E.Neutrophils and acute lung injury.Crit Care Med, 2003,31(4 Suppl):S195-S199.
12. 　Jensen E, Bengtsson A,Berggren H, et al.Clinical variables and pro-inflammatory activation in paediatric heart surgery. Scand Cardiovasc J, 2001,35(3):201-206.
13. 　Asimakopoulos G, Smith PL, Ratnatunga CP,et al. Lung injury andacute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg,1999,68 (3) :1107-1115.
14. 　Haeberle HA, Nesti F, Diet rich HJ, et al.Perflubron reduces lung inflammation in respiratory syncytial virus infection by inhibiting chemokine expression and nuclear factor-kappa B activation.Am J Respir Crit Care Med, 2002,165(10):1433-1438.
15. 　Koch T, Ragaller M, Haufe D, et al. Perfluorohexane attenuates proinflammatory and procoagulatory response of activated monocytes and alveolar macrophages. Anesthesiology,2001, 94(1):101-109.
16. 　Schroeder S, Brger N, Wrigge H, et al. A tumor necrosis factor gene polymorphism influences the inflammatory response after cardiac operation. Ann Thorac Surg, 2003,75(2):534-537.
17. 　Decleva E, Dri P, Menegazzi R, et al. Evidence that TNF-induced respiratory burst of adherent PMN is mediated by integrin alpha(L) beta (2).J Leukoc Biol, 2002,72(4):718-726.
18. 　Maianski NA, Roos D, Kuijpers TW. Tumor necrosis factor alpha induces a caspase independent death pathway in human neutrophils. Blood, 2003, 101(5):1987-1995.
19. 　Hill GE, Whitten CW, Landers DF. The influence of cardiopulmonary bypass on cytokines and cell-cell commu-nication. J Cardiothorac Vasc Anesth, 1997,11(3):367-375.
20. 　Zheng JH, Xu ZW, Wang W, et al. Lung perfusion with oxygenated blood during aortic clamping prevents lung injury. Asian Cardiovasc Thorac Ann, 2004,12(1):58-60.
21. 　Liu Y, Wang Q, Zhu X, et al. Pulmonary artery perfusion with protective solution reduces lung injury after cardiopulmonary bypass.Ann Thorac Surg, 2000, 69(5):1402-1407.
22. 　von der Hardt K, Schoof E,Kandler MA,et al. Aerosolized perfluorocarbon suppresses early pulmonary inflasmmatory response in a surfactant-depleted piglet model.Pediatrc Res,2002,51(2):177-182.

《中國胸心血管外科臨床雜志》

全氟化碳對體外循環肺損傷保護的實驗研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國胸心血管外科臨床雜志》

全氟化碳對體外循環肺損傷保護的實驗研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料