体外循环控氧灌注保护犬肺缺血再灌注损伤 - 第三军医大学学报.doc

体外循环控氧灌注保护犬肺缺血再灌注损伤 黄邵洪1，覃杰2，荣健3，吴钟凯3 (510630广州，中山大学附属第三医院胸心外科1，510080广州，中山大学附属第三医院放射科2，510080广州，中山大学附属第一医院心脏外科3) [摘 要] 目的 探讨体外循环中控氧灌注对肺缺血再灌注早期损伤的影响。方法14只健康犬随机分为对照组和实验组，每组7只，开胸建立体外循环，经过60min升主动脉阻断和90min再灌注。实验组在主动脉开放瞬间FiO2为40 %，随后每5 min依次上调10 %，最后达80 %并保持至实验结束，对照组开放后再灌注全程FiO2 保持80 %不变。检测动脉血气，观察两组犬在麻醉后、主动脉开放前、开放后5 min、10 min、15 min、20 min、25 min以及停机前动脉血氧分压的变化。在开胸后（T1）、主动脉开放后25 min（T2）、90 min（T3）分别留取血液标本及肺标本。检测血清白介素6（IL-6）和肿瘤坏死因子α（TNF-α）含量；肺组织高迁移族蛋白1（HMGB1）、髓过氧化物酶（MPO）活性、丙二醛（MDA）、核因子kappa B 蛋白（NF-κB）含量；肺组织干湿重比及光镜下病理变化。结果 实验组动脉血氧分压在主动脉开放后各时点均低于对照组（P0.05）。实验组与对照组比较，血清IL-6和TNF-α，肺组织HMGB1、MPO活性、MDA、NF-κB等在T2和T3时点水平较低，存在显著性差异（P0.05）。实验组肺组织干湿重比在T2和T3时点高于对照组，病理改变也较轻。结论 体外循环中采用控氧灌注对肺缺血再灌注早期损伤有一定保护作用。 [关键词] 控氧灌注；肺；缺血再灌注损伤 [中图分类号 [基金项目] 国家重点基础研究发展计划资助项目（2010CB529500）, 中山大学5010计划项目（2007008） [通信作者] 吴钟凯，电话E-mail：jiji126@126.comOxygen controlled reperfusion during cardiopulmonary bypass protect lung ischemic reperfusion in canine Huang Shaohong1, Qing Jie2, Rong Jian3, Wu Zhongkai3(1Department of Thoracocardiac Surgery, The Third Affiliated Hospital, Sun Yet-sen University, Guangzhou, 510630, China. 2Department of Radiology, The Third Affiliated Hospital, Sun Yet-sen University, Guangzhou, 510630, China.3Department of Cardiac Surgery, The First Affiliated Hospital, Sun Yet-sen University, Guangzhou 510080, China.) [Abstract] Objectives To observe the effects of oxygen controlled reperfusion on lung ischemic reperfusion injury in cardiopulmonary bypass(CPB). Methods Fourteen canines were randomized into I/R(ischemic reperfusion , n=7) group and OCR(oxygen controlled reperfusion , n=7) group. Both groups received 60 min aortic clamping followed by 90 min reperfusion after thoracotomy and CPB establishment. In group I/R, the animals received steady 80 % FiO2 during reperfusion stage; In group OCR, the animals received 40 % FiO2 immediately after aortic declamping, then FiO2 increased 10% every five minutes till reaching 80%, which last to the end of CPB. Other procedures