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Title:: Effect of extracorporeal circulation of thorascopic surgery on canine lung

作者:: 陈涛; 俞世强; 易定华; 杨剑; 徐学增; 赵金超; 魏旭峰; 第四军医大学西京医院心脏外科，陕西西安 710032

Author(s):: CHEN Tao; YU Shiqiang; YI DingHua; YANG Jian; XU Xuezeng; ZHAO Jinchao; WEI XuFeng; Center of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi′an 710032, Shaanxi, China

关键词:: 胸腔镜; 体外循环; 肺损伤; 犬

Keywords:: thoracoscope; extracorporeal circulation; lung tissue injury; dog

分类号:: R561

DOI:: -

文献标识码:: A

摘要:: 目的观察电视胸腔镜下实施犬心脏手术术后其肺组织的损伤情况。方法将30只健康幼龄犬，体质量10～15 kg，随机分成3组（每组10只），常规开胸组（A组）：按常规建立体外循环；胸腔镜组（B组）：经股动脉、股静脉插管后建立体外循环，对照组（C组）：麻醉后接呼吸机不开胸。将3组分别于麻醉诱导后（T1）、主动脉开放后30 min（T2）、主动脉开放后60 min（T3）、主动脉开放后90 min（T4）时，测定血流动力学、肺顺应性、气道阻力及动脉血气分析,并根据公式计算动脉肺泡氧分压比率(PaO2/PAO2 )、肺血管阻力指数（PVRI）、氧合指数（OI）等指标。术后测定各组肺组织的含水量（W/D）、丙二醛（MDA）含量, 并进行病理分析。结果术后各时间点，B组较A组的气道阻力、PVRI略高；肺顺应性、PaO2/PAO2、OI略低，但两组相比较无显著统计学差异。术后两组W/D 、MDA的含量均增高，B组略高于A组，但统计学分析无显著意义。C组各指标无明显差异，与两手术组比较，气道阻力、PVRI、W/D 、MDA较低，肺顺应性、PaO2/PAO2、OI较高，有显著统计学意义。病理分析: B组肺泡结构破坏,肺组织有中性粒细胞浸润, 间质水肿，与A组相近，C组肺组织结构未见异常。结论小儿胸腔镜体外循环心脏手术术后，对肺组织的影响与常规体外循环近似。

Abstract:: AIM To observe the extent of lung tissue damage after undergoing extracorporeal circulation (ECC) for video assistant thorascopic operation in dogs. METHODS Thirty immature dogs with a body weight of 10~15 kg were randomly divided into three groups (n=10): the routine group (group A), the thorascope group (group B) and the control group (group C). ECC was established in group A by routine procedures, ECC ingroup B was set up by the right femoral artery and femoral venous and control group only took the breathing machine without opening chest. Hemodynamics, lung compliance, airway resistance and arterial blood gas were assessed at the following time points: after induction of anesthesia（T1）, 0.5 hour after aortic opening（T2）, 1 hour after aortic opening（T3） and 1.5 hours after aortic opening（T4）. Artery alveolar O2 pressure ratio（PaO2/PAO2）, pulmonary vascular resistance index （PVRI）and oxygenation index (OI) were then calculated. Lung water and malondialdehyde content were assessed and histological evaluation was made. RESULTS No significant differences were observed in pulmonary function parameters between group A and group B after operation. But compared with those in group A, the airway resistance and pulmonary vascular resistance index in group B were higher while the lung compliance, arteryalveolar O2 pressure ratio and oxygenation index (OI) were lower. Less lung water was observed and the malondialdehyde content in the pulmonary tissue was lower. No significant differences were observed in pulmonary function parameters in group C. But compared with those in group A and group B, the airway resistance, pulmonary vascular resistance index, lung water and malondialdehyde in group C were lower, while the lung compliance, arteryalveolar O2 pressure ratio and oxygenation index (OI) were higher. Under the optical microscope, the pulmonary architecture was destroyed, abundant intraalveolar neutrophils and interstitial edema were seen in group A and group B and all of the histological changes in group B were more serious than those in group A. The pulmonary architecture was normal in C group. CONCLUSION The extent of lung tissue damage in dogs after undergoing ECC for videoassistant thorascopic operation is similar to that following routine extracorporeal circulation.

参考文献/References

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电视胸腔镜下心脏手术对犬肺组织的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

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