本文選題：纖維支氣管鏡肺減容術(shù) + 綿羊��； 參考：《天津醫(yī)科大學(xué)》2007年碩士論文

【摘要】： 目的：研究應(yīng)用木瓜蛋白酶局部氣管內(nèi)滴注法建立纖維支氣管鏡肺減容術(shù)所需綿羊不均一肺氣腫模型的安全性及其特點，并初步研究肺氣腫電鏡下病理學(xué)改變。 方法：健康成年綿羊20只，麻醉后氣管內(nèi)插管，局部肺段滴注木瓜蛋白酶75U／kg，同時麻醉機給予正壓通氣15分鐘，潮氣量12ml／kg，呼吸頻率15次／min，氧流量6L／min，連續(xù)4周制成不均一肺氣腫模型。模型制作完2周后觀察血氣分析、肺功能及影像學(xué)改變。將其中6只動物處死(靜脈注射戊巴比妥鈉100mg／kg)，取出完整肺組織，將其充氣并放置在2.5L生理鹽水中，保持肺組織處于20cmH_2O的壓力中。將滴注木瓜蛋白酶的靶段肺組織及未滴注的肺組織分別取材，經(jīng)光學(xué)顯微鏡觀察其病理學(xué)改變，透射電鏡下觀察各細胞的亞細胞結(jié)構(gòu)改變肺組織病理學(xué)改變。 結(jié)果：20只綿羊中的17只成功復(fù)制出肺氣腫模型，成功率85％，其余1只由于肺大泡破裂死亡(5％)，1只死于雙肺感染并發(fā)膿胸(5％)，另外1只由于術(shù)前禁食時間短，導(dǎo)致嘔吐窒息死亡(5％)。17只成功復(fù)制出肺氣腫模型的綿羊中，14只整個模型建立過程中未出現(xiàn)不良反應(yīng)，3只出現(xiàn)間斷咳嗽。實驗前后氧分壓、血氧飽和度改變有統(tǒng)計學(xué)意義，功能殘氣增加量改變有統(tǒng)計學(xué)意義。CT示氣腫肺段肺紋理減少，肺野透過度增加。病理觀察光鏡示肺泡壁變薄、脹大，肺泡融合；電鏡示Ⅱ型肺泡上皮細胞內(nèi)見多量空泡，表面活性物質(zhì)減少，，肺泡腔內(nèi)見有分泌物。肺組織間見有凋亡小體。 結(jié)論：本實驗的特點為(1)不均一的肺氣腫模型與人類所患肺氣腫類型更為接近；(2)氣管內(nèi)滴注方法建立模型穩(wěn)定，方法簡便，注藥劑量準確，制作時間短，不易出現(xiàn)感染及不良反應(yīng)；(3)經(jīng)氣管內(nèi)滴注木瓜蛋白酶免受血液中彈性蛋白酶抑制因子的滅活�？傊竟系鞍酌妇植繗夤軆�(nèi)滴注能成功而安全的復(fù)制綿羊不均—肺氣腫模型，該模型能滿足BLVR動物實驗的要求，CT及病理均證實符合不均—肺氣腫改變。
[Abstract]:Objective: to study the safety and characteristics of sheep heterogeneous emphysema model with papain intratracheal instillation, and to study the pathological changes of emphysema under electron microscope. Methods: 20 healthy adult sheep were intubated with tracheal intubation after anesthesia, 75 U / kg papain was infused into the local lung segment, and positive pressure ventilation was given to the anesthetic machine for 15 minutes. The inhomogeneous emphysema model was made with tidal volume of 12 ml / kg, respiratory rate of 15 times / min and oxygen flow rate of 6 L / min for 4 weeks. Blood gas analysis, pulmonary function and imaging changes were observed 2 weeks after the model was made. Six of the animals were killed (intravenous injection of pentobarbital sodium 100 mg / kg 路kg ~ (-1), the intact lung tissue was taken out, then inflated and placed in 2.5 L saline to keep the lung tissue under the pressure of 20cmH_2O. The target lung tissue and the non-drip lung tissue of papain were collected, the pathological changes were observed by optical microscope, and the pathological changes of lung tissue were observed by transmission electron microscope (TEM). Results the emphysema model was successfully made in 17 of the 20 sheep, and the success rate was 850.The other one died of alveolar rupture, one died of double lung infection and the other one died of bilateral lung infection, and the other one died of short fasting time before operation. 14 of 17 sheep with emphysema were induced to die of vomiting asphyxia. No adverse reactions were found during the establishment of the model and 3 of them had intermittent cough. Before and after the experiment, the changes of oxygen partial pressure and oxygen saturation were statistically significant, and the increase of functional residual gas was statistically significant. Ct showed that the lung texture of emphysema decreased and the permeability of lung field increased. The pathological observation showed that the alveolar wall became thinner, enlarged and fused with alveoli under light microscope, and the vacuole was found in the alveolar epithelial cells of type 鈪

本文編號：1834007