本文關(guān)鍵詞： 七氟醚后處理 體外循環(huán) Bcl-2 Bax 肺缺血再灌注損傷　出處：《遵義醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過研究七氟醚后處理對體外循環(huán)（CPB）犬肺的保護(hù)作用及肺組織中Bcl-2和Bax的變化情況，探討七氟醚肺保護(hù)的可能機(jī)制。 方法：實驗用雜種犬12只，隨機(jī)分為兩組（n=6），左肺缺血再灌注組（C組）、七氟醚后處理組（Y組）。兩組動物均腹腔注射戊巴比妥鈉（25mg·kg-1），麻醉后氣管插管、固定，股動、靜脈置管監(jiān)測平均動脈壓（MAP）、中心靜脈壓（CVP），開胸并建立犬CPB。C組犬左肺行缺血再灌注，Y組犬左肺行缺血再灌注后七氟醚處理。于CPB前（T1）、開放左肺動脈即刻（T2）及停機(jī)后2h（T3）取肺組織光鏡下觀察病理學(xué)變化，采用免疫組化技術(shù)檢測Bcl-2和Bax表達(dá)情況。同時在各時間點取股動脈血，行動脈血氣分析，根據(jù)血氣分析結(jié)果計算呼吸指數(shù)（RI）和氧合指數(shù)（OI），動態(tài)肺順應(yīng)性（Cd）。 結(jié)果：（1）兩組犬肺組織光鏡下病理改變及病理評分：光鏡學(xué)結(jié)果：CPB前，兩組犬肺組織結(jié)構(gòu)清晰，肺泡間隔無明顯增寬，肺泡腔未見填充物。開放左肺動脈后兩組犬肺組織結(jié)構(gòu)均紊亂，大量炎性細(xì)胞浸潤，偶爾有肺泡壁斷裂。停機(jī)后2h， C組肺損傷最嚴(yán)重，肺組織結(jié)構(gòu)紊亂，肺間隔明顯增寬，，大量肺泡壁斷裂，肺泡腔塌陷，同時有紅細(xì)胞漏出；Y組肺組織結(jié)構(gòu)紊亂，部分肺泡腔塌陷及肺泡壁斷裂，肺泡腔見炎性細(xì)胞。病理切片評分：CPB前，兩組犬肺組織病理評分無明顯差異（P0.05）。組內(nèi)比較：兩組犬肺組織病理評分T2明顯高于T（1P 0.05），T3明顯高于T（2P 0.05）。組間比較：T1、T2兩組犬評分無明顯差異（P0.05），T3C組評分明顯高于Y組（P0.05）。 （2）呼吸功能參數(shù)變化：組內(nèi)比較：與T1比較，兩組犬T2、 T3時點RI逐漸升高，而Cd和OI逐漸降低，差異有統(tǒng)計學(xué)意義（P 0.05）；組間比較：兩組犬T1、T2Cd、OI、RI均無明顯差異（P0.05），Y組T3Cd和OI明顯高于C組（P 0.05），而Y組RI明顯低于C組（P 0.05）。 （3）兩組犬肺組織Bcl-2和Bax的表達(dá)：組內(nèi)比較，與T1比較，兩組犬T2、T3肺組織Bcl-2和Bax的表達(dá)明顯高于T1（P 0.05）；組間比較，兩組犬T1、T2同時點肺組織Bcl-2和Bax的表達(dá)無明顯差異（P0.05），T3肺組織Bax的表達(dá)C組明顯高于Y組（P 0.05），肺組織Bcl-2的表達(dá)C組明顯低于Y組（P 0.05）。同時T1、T2肺組織Bcl-2/Bax比值的變化無明顯差異（P0.05），T3肺組織Bcl-2/Bax比值Y組明顯高于C組（P 0.05）。 結(jié)論：七氟醚后處理對犬CPB導(dǎo)致的肺損傷有一定的保護(hù)作用，其機(jī)制可能與促進(jìn)犬肺組織抗凋亡蛋白Bcl-2和抑制促凋亡蛋白Bax的表達(dá)有關(guān)。
[Abstract]:Aim: to investigate the protective effect of sevoflurane on the lung of dogs with cardiopulmonary bypass (CPB) and the changes of Bcl-2 and Bax in lung tissue, and to explore the possible mechanism of sevoflurane lung protection. Methods: twelve mongrel dogs were randomly divided into two groups: group C (group C) and group C (group C). Rats in sevoflurane post-treatment group were given intraperitoneal injection of pentobarbital sodium 25 mg 路kg-1.The mean arterial pressure (MAPP) was monitored by tracheal intubation, fixation, femoral artery and venous catheterization after anesthesia. The left lung of dogs in CPB.C group was treated with sevoflurane after ischemia and reperfusion, and the left lung was treated with sevoflurane before CPB. The pathological changes of lung tissue were observed under light microscope. Immunohistochemical technique was used to detect the expression of Bcl-2 and Bax. At the same time, femoral arterial blood was collected at each time point and arterial blood gas was analyzed. Respiratory index (RI) and oxygenation index (Oi) were calculated according to the results of blood gas analysis. Results the pathological changes and pathological scores of lung tissue under light microscope in two groups: before CPB, the lung structure of the two groups was clear and the alveolar septum did not widen obviously. There was no filling in the alveolar cavity. After the left pulmonary artery was opened, the lung tissue structure of the two groups were all disordered, a large number of inflammatory cells infiltrated, and occasionally the alveolar wall rupture. 2 hours after stopping, the lung injury in group C was the most serious, and the lung tissue structure was disordered. The pulmonary septum was obviously widened, a large number of alveolar walls were ruptured, alveolar cavities collapsed, and red blood cells leaked out. In group Y, the lung tissue structure was disordered, part of alveolar cavity collapsed and alveolar wall was broken, inflammatory cells were seen in alveolar cavity, and pathological section score was before CPB. There was no significant difference in lung pathological score between the two groups (P 0.05). Comparison between the two groups: T2 was significantly higher than that of T1 (P 0.05). There was no significant difference in score between the two groups. The score of T3C group was significantly higher than that of Y group (P 0.05). (2) changes of respiratory function parameters: compared with T1, RI increased gradually at T _ 2 and T _ 3, while CD and OI decreased gradually in two groups (P < 0.05). Comparison between the two groups: there was no significant difference in RI between the two groups. The T3CD and OI of the two groups were significantly higher than those of group C (P 0.05). The RI of group Y was significantly lower than that of group C (P 0.05). (3) expression of Bcl-2 and Bax in lung tissue of two groups: compared with T1, T2 in both groups. The expression of Bcl-2 and Bax in T3 lung tissue was significantly higher than that in T 1 lung tissue (P 0.05). There was no significant difference in the expression of Bcl-2 and Bax between the two groups (P 0.05). The expression of Bax in group C was significantly higher than that in group Y (P 0.05), and the expression of Bcl-2 in group C was significantly lower than that in group Y (P 0.05). There was no significant difference in Bcl-2/Bax ratio between T 2 and T 2 lung tissues. The ratio of Bcl-2/Bax in T 2 lung tissue in group Y was significantly higher than that in group C (P 0.05). Conclusion: sevoflurane post-treatment has a protective effect on lung injury induced by CPB in dogs, and its mechanism may be related to promoting the expression of anti-apoptotic protein Bcl-2 and inhibiting the expression of pro-apoptotic protein Bax in canine lung tissue.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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