本文選題：單肺通氣 + 肺萎陷程度��； 參考：《廣東醫(yī)學(xué)》2017年15期

【摘要】：目的利用一種新型肺隔離通氣工具,探討開胸手術(shù)控制犬肺萎陷與肺早期損傷的相關(guān)性。方法按完全隨機(jī)法將18只實(shí)驗(yàn)犬分為3組(G1組、G2組、G3組),全身麻醉后插入控制肺內(nèi)平衡分氣肺隔離導(dǎo)管,股動、靜脈穿刺置管,右頸內(nèi)靜脈置入Swan-Ganz漂浮導(dǎo)管,首先均雙肺通氣(two lung ventilation,TLV)20 min,后進(jìn)行左側(cè)單肺通氣(one lung ventilation,OLV),萎陷程度依次為100%(G1組)、90%(G2組)、50%(G3組),分別在肺萎陷前(T0),肺萎陷后30 min(T1)、60 min(T2)、120 min(T3)經(jīng)股動脈和頸靜脈取血液標(biāo)本行血?dú)夥治鰷y定分流率(Qs/Qt),ELISA測定血清腫瘤壞死因子-α(TNF-α)和白細(xì)胞介素-6(IL-6)含量;實(shí)驗(yàn)中持續(xù)監(jiān)測股動脈血壓、心率、肺動脈壓等生理數(shù)據(jù),在T3時取肺組織檢測肺組織濕干重比(wet/dry weight ratio,W/D);病理切片HE染色,顯微鏡觀察并盲法評分比較肺組織病理學(xué)變化。結(jié)果各組在TLV時測得的各方面生理指標(biāo)均差異無統(tǒng)計學(xué)意義(P0.05);OLV后,與G1組比較,G2、G3組平均肺動脈壓(MPAP)較為平穩(wěn),差異有統(tǒng)計學(xué)意義(P0.05);肺內(nèi)分流率Qs/Qt、W/D及TNF-α、IL-6含量降低,肺組織水腫、出血、炎癥細(xì)胞浸潤程度及肺損傷評分降低。G2組與G3組在各時間點(diǎn)的各項(xiàng)指標(biāo)差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論與完全肺萎陷(萎陷程度100%)相比,控制性肺萎陷(萎陷程度90%和50%)能更好地減輕術(shù)中肺損傷,但萎陷程度90%與50%之間未見明顯差異。
[Abstract]:Objective to investigate the relationship between lung collapse control and early lung injury in dogs with open chest surgery using a new lung isolation ventilation tool. Methods Eighteen dogs were randomly divided into 3 groups (G _ 1 group, G _ 2 group and G _ 3 group). After general anesthesia, the Swan-Ganz floating catheter was inserted into the right internal jugular vein. The degree of wilting was 100% (G1 group) 90% (G2 group) 50% (G3 group) respectively before lung collapse (T0) and 30 min (T1) 60 min (T2) after lung atrophy. Blood samples were collected from femoral artery and jugular vein for 120 min (T3). Serum tumor necrosis factor- 偽 (TNF- 偽) and interleukin-6 (IL-6) were determined by Elisa. The physiological data of femoral artery blood pressure, heart rate and pulmonary artery pressure were continuously monitored. Lung tissues were taken at T3 to detect wet/dry weight wet / dry weight ratio (WR / D), pathological sections were stained with HE, observed by microscope and compared with pathological changes by blind method. Results after OLV, the mean pulmonary artery pressure (MPAP) of G2G3 group was more stable than that of G1 group (P0.05), and the mean pulmonary artery pressure (MPAP) of G2G3 group was significantly higher than that of G1 group (P0.05). Bleeding, inflammatory cell infiltration and lung injury score decreased. G2 group and G3 group at each time point in the index difference was not statistically significant (P0.05). Conclusion compared with complete lung collapse (100%), controlled pulmonary atrophy (90% and 50%) can reduce lung injury more effectively, but there is no significant difference between 90% and 50%.
【作者單位】： 南方醫(yī)科大學(xué)南方醫(yī)院麻醉科;中山大學(xué)中法核工程與技術(shù)學(xué)院;復(fù)旦大學(xué)中山醫(yī)院耳鼻喉科;中山大學(xué)孫逸仙紀(jì)念醫(yī)院麻醉科;
【基金】：廣東省科技計劃項(xiàng)目(編號:2016B090918111)
【分類號】：R614

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