体外膜肺氧合对急性肺损伤犬血浆粘附分子影响.doc

体外膜肺氧合对急性肺损伤犬血浆粘附分子影响.doc

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体外膜肺氧合对急性肺损伤犬血浆粘附分子影响

体外膜肺氧合对急性肺损伤犬血浆粘附分子影响   作者:周成斌,张镜芳,章晓华,庄建,祁周措,姚丽明 【摘要】 目的 探讨经皮穿刺静脉-静脉体外膜肺氧合(ECMO)对急性肺损伤犬血浆粘附分子的影响。方法 10头雄性犬利用油酸建立急性肺损伤模型,随机分为机械通气组(MV组,n=5)和ECMO组(n=5),观察肺损伤4 h。经皮穿刺右颈内静脉和右股静脉建立ECMO转流,灌注流量35~40 ml/(kg·min)。记录肺损伤形成时、肺损伤2h、肺损伤4 h动脉血气值、肺动态顺应性的变化,用ELISA方法检测血浆细胞间粘附分子1(ICAM-1)和P选择素。结果 两组各时间点血气值总体差异没有统计学意义。在肺损伤2 h、4 h两组肺动态顺应性总体差异有统计学意义(F=5.84,P=0.042),ECMO组低于MV组。ECMO组在肺损伤2 h、4 h血浆 ICAM-1和P-选择素显著增高(P<0.05),两组总体差异有统计学意义(ICAM-1的F=8.716,P=0.018;P-Selection的F=20.373,P=0.002)。结论 经皮穿刺静脉-静脉ECMO有效促进急性肺损伤犬的血液氧合和二氧化碳排出,但增加血浆粘附分子水平,影响肺动态顺应性。 【关键词】 急性肺损伤;体外膜肺氧合;粘附分子   Abstract: OBJECTIVE To investigate the effects of percutaneous venous-venous extracorporeal membrane oxygenation (ECMO) on plasma adhesion molecule in canines with acute lung injury (ALI). METHODS Ten canines with ALI caused by the injection of oleic acid were divided into a control (mechanical ventilation, MV) group and an ECMO group, and performed experience for 4 hours. The device of V-V ECMO connected with a cannular percutaneously inserted through right jugular vein and a cannular percutaneously inserted through right femoral vein. The perfusion flow from 35 to 40 ml/(kg·min). The arterial blood gas and lung dynamic compliance were recorded at the beginning of ALI, ALI 2 hours, ALI 4 hours. Plasma intercellular adhesion molecular-1(ICAM-1) and P-Selectin were detected by ELISA. RESULTS There was no difference between two groups in the arterial blood gas. The lung dynamic compliance of ECMO group were lower than that of MV group(F=5.84,P=0.042). There was noticeable increase in Plasma ICAM-1 and P-Selectin of ECMO group compared with MV group(ICAM-1, F=8.716,P=0.018; P-Selection, F=20.373,P=0.002). CONCLUSION Percutaneous venous-venous ECMO can efficiently take in blood oxygen and take off blood carbon dioxide in canines with ALI, increase the plasma ICAM-1 and P-Selectin, and decrease the lung dynamic compliance.   Key words: Acute lung injury;Extracorporeal membrane oxygenation;Adhesion molecule   体外膜肺氧合(ECMO)用于心肺功

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