七氟醚或缺血预处理对大鼠肺缺血再灌注时ERK和CaM表达的影响

目的 探讨七氟醚或缺血预处理对大鼠肺缺血再灌注时细胞外信号调节蛋白激酶(ERK)和钙调素(CaM)表达的影响.方法 健康雄性SD大鼠24只,体重270～320 g,随机分为4组(n=6):假手术组(S组)、肺缺血再灌注组(IR组)、缺血预处理组(IP组)和七氟醚预处理组(SP组).IR组采用夹闭左肺门45 min恢复灌注120 min的方法制备肺缺血再灌注损伤模型,IP组缺血前夹闭左肺门缺血5 min恢复灌注5 min,连续2次,SP组缺血前吸人2.1%七氟醚30 min.于再灌注120 min时取左肺组织,测定TNF-α和IL-6含量、ERK mRNA和CaM mRNA的表达水平.结果 与S组比较,IR组、IP组和SP组肺组织TNF-α和IL-6的含量、ERK mRNA和CaM mRNA的表达水平升高(P＜0.05);与IR组比较,IP组和SP组肺组织TNF-α和IL-6的含量和CaM mRNA的表达水平降低,ERK mRNA表达水平升高(P＜0.05);SP组和IP组各指标比较差异无统计学意义(P＞0.05).结论七氟醚预处理和缺血预处理均通过下调CaM表达和上调ERK表达减轻大鼠肺缺血再灌注损伤.     

异氟醚对大鼠肺缺血再灌注损伤的保护作用

目的 探讨异氟醚对大鼠肺缺血再灌注损伤的保护作用。方法 120只SD雄性大鼠，随机分成4组（n=30）：假手术组（S组）、缺血再灌注组（IR组）、异氟醚-缺血再灌注组（ISO-IR组）和异氟醚组（ISO-S组）。IR组、ISO-IR组建立肺缺血再灌注模型，ISO-IR组吸入1MAC异氟醚30min时行肺缺血再灌注，ISO-S组吸入1MAC异氟醚，不进行肺缺血再灌注。分别在缺血45min、再灌注30、60、120min处死6只大鼠，测定肺组织湿干比（W／D）、髓过氧化物酶（MPO）活性、中性粒细胞（PMN）膜表面CD18和肺组织ICAM-1mRNA表达、支气管肺泡灌洗液（BALF）中自细胞计数、沉渣白细胞分类和总蛋白（TP）浓度，并进行肺组织病理学检查。结果 再灌注期间IR组肺组织W／D、MPO活性、CDl8和ICAM-1mRNA表达、BALF中PMN百分比、TP浓度及PMN膜表面CD18表达均升高。而异氟醚预先给药减弱了缺血再灌注诱导的上述指标的升高。肺组织病理学检查显示异氟醚预先给药减轻了肺缺血再灌注损伤。结论 通过抑制PMN浸润和肺组织ICAM-1mRNA及CD18表达上调，缺血前吸入异氟醚对肺缺血再灌注损伤有一定的保护作用。     

七氟醚预处理对大鼠内毒素性急性肺损伤的影响

目的 探讨七氟醚预处理对大鼠内毒素性急性肺损伤的影响.方法 健康雄性SD大鼠24只,体重220～250 g,随机分为4组(n=6):对照组(c组)、内毒素组(LPS组)、七氟醚组(Sev组)和七氟醚预处理组(SP组).C组和LPS组机械通气30 min后分别静脉注射生理盐水和脂多糖(LPS)5 mg/kg;Sev组和SP组吸入七氟醚(呼气末浓度2.4%)30 min,洗脱5 min,然后分别静脉注射生理盐水和LPS 5 mg/kg.于给予LPS或生理盐水后6 h时,心脏放血处死大鼠,取肺组织,计算湿重/干重(W/D)比;采用弥漫性肺泡损伤(DAD)评分评价肺组织损伤程度;测定肺组织髓过氧化物酶(MPO)活性、细胞因子诱导中性粒细胞化学趋化因子-1(CINC-1)含量、CINC-1和CINC-1 mRNA的表达水平.结果 与C组比较,LPS组和SP组肺组织W/D比、DAD评分、MPO活性和CINC-1含量升高,CINC-1和CINC-1 mRNA的表达上调(P<0.01),Sev组上述指标差异无统计学意义(P>0.05);与LPS组比较,SP组肺组织W/D比、DAD评分、MPO活性和CINC-1含量降低,CINC-1和CINC-1 mRNA的表达下调(P<0.01).结论 七氟醚预处理可减轻大鼠内毒素性急性肺损伤,可能与其抑制肺组织炎性反应有关.     

异丙酚对肺缺血再灌注损伤大鼠肺上皮细胞凋亡的影响

目的拟通过观察肺上皮细胞凋亡的变化,探讨异丙酚减轻大鼠肺缺血再灌注损伤的作用机制。方法雄性SD大鼠136只,随机分为3组:假手术组(S组,n=24)、缺血再灌注组(I/R组,n=56)、异丙酚组(P组,n=56)。I/R组、P组制备大鼠肺原位热缺血模型,缺血1h。P组于缺血前30min静脉输注异丙酚20mg·kg~(-1)·h~(-1)至再灌注4h。S组除不作缺血处理外,其余处理与I/R组相同。分别于再灌注0.5、1、2、4h随机处死大鼠(S组每个时点处死6只,I/R组、P组每个时点分别处死14只大鼠),每组每个时点的一半大鼠用于测定支气管肺泡灌洗液(BALF)中中性粒细胞百分比、蛋白浓度,另外一半大鼠用于测定肺组织丙二醛(MDA)含量、湿,干重比(W/D)及肺上皮细胞凋亡指数(TUNEL法),并在光镜下观察肺组织的病理学改变;I/R组、P组肺上皮细胞凋亡指数与W/D进行直线相关分析。结果与S组相比,I/R组和P组再灌注各时点BALF中中性粒细胞百分比、蛋白浓度及肺组织MDA含量、W/D、肺上皮细胞凋亡指数均增加(P<0.05或0.01);与I/R组比较,P组上述指标均降低(P<0.05或0.01),肺组织病理学损伤减轻;I/R组、P组肺上皮细胞凋亡指数与W/D之间的相关系数分别为0.784、0.830(P<0.01)。结论异丙酚抑制肺上皮细胞凋亡可能是减轻大鼠肺缺血再灌注损伤的机制之一。     

七氟烷预先给药对大鼠肺缺血再灌注时紧密连接蛋白表达的影响

目的 探讨七氟烷预先给药对大鼠肺缺血再灌注时紧密连接蛋白(Occludie和ZO-1)表达的影响.方法 雄性Wistar大鼠96只,体重250～350 g,随机分为4组(n=24):假手术组(S组)仅游离左肺门,但不阻断;肺缺血再灌注组(I/R组)采用阻断左肺门45 min恢复灌注120 min的方法制备大鼠肺缺血再灌注模型;七氟烷组(Sevo组)吸入2.2%七氟烷30 min后游离肺门,但不阻断;七氟烷预先给药组(SP组)吸入2.2%七氟烷30 min后制备模型.于缺血45 min、再灌注60和120 min(T1～3)时各组随机取6只大鼠处死取肺,称重后计算肺湿干重比,光镜下观察肺组织病理学结果,采用Western blot法检测肺组织Occludin和ZO-1的表达.于再灌注120 min时各组余6只大鼠行支气管肺泡灌洗,取左颈动脉血样,采用Bradford法测定支气管肺泡灌洗液蛋白及血清总蛋白浓度,计算肺血管通透性指数.结果 与S组比较,I/R组和SP组T2,3时肺湿干重比、T3时肺血管通透性指数升高,肺组织Occludin和ZO-1表达下调(P＜0.05),Sevo组上述指标差异无统计学意义(P＞0.05);与I/R组比较,SP组T2,3时肺湿干重比、T3时肺血管通透性指数降低,肺组织Occludin和ZO-1表达上调(P＜0.05).SP组肺组织病理学损伤较I/R组明显减轻.结论 七氟烷预先给药可能通过上调Occludin和ZO-1的表达减轻大鼠肺缺血再灌注损伤.     

七氟醚预处理对大鼠心肌缺血再灌注时缝隙连接蛋白43的影响

目的 评价七氟醚预处理对大鼠心肌缺血再灌注时缝隙连接蛋白43的影响.方法 健康成年雄性Wistar大鼠,体重220 ～ 250 g,采用改良Langendorff灌注装置制备离体心脏灌注模型.取离体心脏模型16个,采用随机数字表法,将其随机分为2组(n=8):缺血再灌注组(I/R组)和七氟醚预处理组(SP组).平衡灌注30 min时,I/R组继续灌注K-H液20 min;SP组将2.4％七氟醚持续吹入K-H液中,用预充2.4％七氟醚的K-H液持续灌注15 min,然后用K-H液洗脱5 min.之后两组均行全心缺血40 min,再灌注60 min.分别于平衡灌注末、缺血前即刻、再灌注30和60 min时,记录HR、左室发展压(LVDP)、左心室内压最大上升速率(+dp/dtmax)及左心室内压最大下降速率(- dp/dtmax).于再灌注60 min时,取部分心尖组织,观察心肌病理学改变;取左室部分心肌,观察缝隙连接蛋白43的分布情况,测定缝隙连接蛋白43的表达.结果 与平衡灌注末比较,I/R组和SP组缺血前即刻+ dp/dtmax和- dp/dtmax降低,再灌注30和60 min时HR、LVDP、+dp/dtmax和- dp/dtmax降低(P＜0.01);与缺血前即刻比较,I/R组和SP组再灌注30和60 min时HR、LVDP、+dp/dtmax和- dp/dtmax降低(P ＜0.05或0.01);与I/R组比较,SP组缺血前即刻HR、LVDP、+dp/dtmax和- dp/dtmax降低,再灌注30和60 min时HR、LVDP、+dp/dtmax和- dp/dtmax升高(P＜0.01),病理学损伤减轻.缝隙连接蛋白43 I/R组分布不均,闰盘处少见;SP组分布规律呈条带状,主要位于闰盘处.两组缝隙连接蛋白43表达比较差异无统计学意义(P＞0.05).结论 七氟醚预处理减轻大鼠心肌缺血再灌注损伤的机制可能与抑制缝隙连接蛋白43的再分布有关,而与缝隙连接蛋白43的表达无关.     

异氟醚对大鼠肺缺血-再灌注损伤的影响

目的探讨异氟醚对大鼠肺缺血-再灌注损伤的影响.方法建立在体大鼠肺缺血-再灌注模型.120只SD雄性大鼠,随机分成四组：缺血-再灌注组（IR组）,异氟醚-缺血-再灌注组（ISO-IR组）,异氟醚组（ISO-C组）和手术对照组（C组）,每组30只.分别在缺血45 min、再灌注30、60、120 min处死大鼠行动脉血气分析、肺组织湿干比（W/D）值、丙二醛（MDA）含量及髓过氧化物酶（MPO）活性测定和肺组织病理学检查;此外,各组于再灌注120 min时另处死大鼠行支气管肺泡灌洗,取灌洗液（BALF）行白细胞计数、沉渣白细胞分类和BALF中总蛋白（TP）含量测定.结果再灌注后,IR组和ISO-IR组肺组织W/D值、MDA含量和MPO活性逐渐升高,且显著高于C组（P〈0.05）;但再灌注60 min后,ISO-IR组肺组织W/D值、MDA含量和MPO活性较IR组均有所降低（P〈0.05）.IR组BALF中的中性粒细胞（PMN）所占百分比较C组显著升高（P〈0.05）,而ISO-IR组的升高并不显著但较IR组显著降低;IR组和ISO-IR组BALF中TP含量均较C组显著升高（P〈0.05）,但ISO-IR组又低于IR组（P〈0.05）;肺组织病理学检查示ISO-IR组病理学变化较IR组显著减轻.结论异氟醚的吸入对缺血-再灌注损伤的肺组织具有一定的保护作用.     

七氟醚对在体大鼠肺缺血-再灌注损伤的影响

目的研究七氟醚对在体大鼠肺缺血-再灌注(I-R)损伤的影响。方法40只Wistar大鼠建立在体大鼠肺I-R模型,随机分为四组,每组10只:A组,假手术组,开胸后机械通气120 min;B组,I-R组,阻断左肺门60 min,开放再通气60 min;C组,七氟醚加I-R组,缺血前吸入1 MAC七氟醚30 min,开放再通气同时吸入1 MAC七氟醚60 min;D组,七氟醚组,持续吸入1 MAC七氟醚120min。观察各组实验结束时肺组织的湿/干重比(W/D)、肺丙二醛(MDA)、超氧化物歧化酶(SOD)和肺组织病理学的改变。结果B组及C组肺W/D较A组和D组显著升高(P<0.01,P<0.05),SOD含量显著低于A组和D组(P<0.05);B组肺MDA含量较A组和D组显著升高(P<0.01),C组肺MDA含量较B组低(P<0.05);C组肺W/D、肺MDA显著低于B组(P<0.05),SOD高于B组(P<0.05);病理切片见B组、C组部分肺泡结构破坏,肺泡间隔增宽,肺泡腔内水肿并有出血,以B组改变较为严重,炎症积分显著高于C组(P<0.01)。结论七氟醚对在体大鼠肺I-R损伤有一定的保护作用。     

乳化异氟醚对大鼠肺缺血-再灌注内质网应激的影响

目的探索乳化异氟醚预处理对大鼠肺缺血-再灌注损伤诱导内质网应激的影响。方法雄性SD大鼠32只随机分成四组:假手术组(S组)、缺血-再灌注组(IR组)、乳化异氟醚预处理(EI组)、脂肪乳组(IL组)。S组腹腔注射生理盐水10.5ml/kg,24h后仅开胸游离左肺门,不进行阻断左肺门;IR组、EI组和IL组分别腹腔注射生理盐水、8%乳化异氟醚10.5 ml/kg、30%脂肪乳10.5ml/kg,24h后通过阻断左肺门1h后再灌注2h建立大鼠原位肺缺血-再灌注损伤模型。于再灌注2h即刻经左心室采集血样检测PaO2、PaCO2值;取左肺组织测湿重/干重比(W/D),通过HE染色评估肺组织病理损伤程度;通过RT-PCR和Western blot检测肺组织中GRP78和CHOP的表达水平。结果与S组比较,IR组、EI组和IL组PaCO2、肺组织GRP78、CHOP mRNA和CHOP蛋白表达明显升高,PaO2明显降低(P0.05),GRP78蛋白表达水平差异无统计学意义;与IR组比较,EI组、IL组PaCO2、肺组织GRP78mRNA、CHOP mRNA和CHOP蛋白表达明显降低、PaO2明显升高(P0.05),GRP78蛋白表达水平差异无统计学意义。与IL组比较,EI组PaCO2、肺组织W/D、GRP78、CHOP mRNA和CHOP蛋白表达明显降低、PaO2明显升高(P0.05),GRP78蛋白表达水平差异无统计学意义。病理显示EI组和IL组肺损伤轻于IR组,EI组肺损伤轻于IL组。结论乳化异氟醚和脂肪乳预处理均可减轻大鼠术后肺缺血-再灌注损伤引起的过度内质网应激,并且乳化异氟醚的保护效果更显著。     

Technetium-fibrinogen lung scanning in canine lung contusion

To detect experimentally induced acute lung contusion in anesthetized dogs, serial radionuclide images of the lung were recorded following intravenous infusion of 99mTc-labelled human fibrinogen (Tc-HF). The accumulation of Tc-HF in canine lungs was serially quantitated for up to 20 hours after lung contusion. A contusion (#1) was produced in one lung, Tc-HF was injected IV after 15 minutes, and 75 minutes later a contralateral lung contusion (#2) was produced in a series of 14 dogs. At autopsy the excised lungs were scanned, sectioned, and counted for radioactivity. Radiolabelled fibrinogen accumulated within 2-4 minutes of contusion #2 and remained stable over the next 20 hours in 14 dogs; contusion #1 was barely visible in four dogs. Lung Tc-HF activity in the central region of contusion #2 remained sixfold higher than in normal lung tissue. These data suggest that following lung contusion, fibrinogen deposition occurs rapidly and remains stable over a 20-hour interval of observation.     

Videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease

Objective: Interstitial lung diseases (ILD) require lung biopsy for the diagnosis in more than 30% of patients. Open lung biopsy (OLB) was generally considered the most reliable method of biopsy and tissue diagnosis. This study tests the diagnostic accuracy and safety of the videothoracoscopic lung biopsy (VTLB) in the diagnosis of ILD. Methods: During the last 5 years, 58 patients were submitted to VTLB under general anesthesia. The mean age was 49.6±12.0 years (range 21–69). All the biopsies were performed by an endostapler EndoPath 30 or 45. Conversion to minithoracotomy was necessary in only one patient because of extensive pleural sinfisis. All the specimens were sent to the microbiology and pathology department for microbiological and histopathological diagnosis. One chest-tube (28F) was positioned and connected to a drainage-system and placed on suction. Results: The histopathological diagnosis was obtained for all patients and therefore the diagnostic accuracy of the procedure was 100%. No postoperative haemothorax occurred and only two patients experienced a prolonged air-leakage (3.4%). The median duration of the chest-drain was 3 days (range 1–7) and the median hospital stay was 4 days (range 2–7). Conclusion: VTLB provides adequate specimen volume for histopathologic diagnosis and achieves a very high diagnostic accuracy (100% in our series). The postoperative morbidity and mortality rates are lower than those related to OLB. We conclude that VTLB is an effective and safe procedure in the diagnosis of ILD.     

C型臂CT在肺结节活检术中的应用价值

目的探讨C型臂CT在肺结节活检术中的应用价值。方法根据活检方法将57次肺活检术（56例患者）分为传统方法组和改进方法组,比较2组阳性率、并发症发生率及辐射剂量,分析肺活检术阳性率和并发症的影响因素。结果传统方法组及改进方法组肺活检阳性率分别为69.44%（25/36）和95.24%（20/21）,差异有统计学意义（P=0.049）。改进方法组的辐射累积剂量及有效剂量均高于传统方法组,差异有统计学意义（P均〈0.05）。活检方法是活检阳性率的独立影响因素。结论 C型臂CT可明显提高肺结节穿刺准确率,有重要临床应用价值。     

Allotransplantation of the lung in dogs with experimental lung damage

In 8 dogs, bilateral pulmonary emphysema was induced by intratracheal instillations of papain, and in 6 dogs, unilateral emphysema was induced by bronchoscopic instillation of papain in the right main bronchus. Development of emphysema was documented by weekly pulmonary function studies. Lung compliance and functional residual capacity were increased, and airway resistance was increased in forced ventilation. When emphysema was established, unilateral allotransplantation of the lung was performed. Postoperative studies of lung function showed no serious ventilation-perfusion imbalance. Ventilatory function and oxygen consumption of the graft were at least equal to the animal's own damaged lung. Respiratory insufficiency and death were always accompanied by rejection or severe infection. It is concluded that postoperative respiratory failure was not due to difference of airway and vascular resistance between the damaged lung and the graft.

---

Résumé Un emphysème pulmonaire bilatéral a été créé chez 8 chiens par installation intratrachéale de papaïne, et unilatéral chez 6 par installation de papaïne dans la bronche souche droite. Le développement de l'emphysème a été contrôlé de semaine en semaine par tests fonctionnels pulmonaires. La compliance pulmonaire et la capacité résiduelle fonctionnelle se sont élevées, ainsi que la résistance des voies aériennes en ventilation forcée. Un fois l'emphysème installé, les animaux ont reçu un allotransplant pulmonaire unilatéral. Les études post-opératoires de la fonction pulmonaire n'ont pas montré de déséquilibre important ventilation-perfusion. La fonction ventilatoire et la consommation d'oxygène du poumon transplanté étaient au moins égales à celles du poumon lésé laissé en place chez l'animal. L'insuffisance respiratoire et les décès ont toujours été concommittents de rejets ou d'infections graves. L'insuffisance respiratoire post-opératoire n'est donc pas due à des déséquilibres de résistance aérienne ou vasculaire entre le poumon lésé et le poumon transplanté.

---

---

Presented at the XXVIIth Congress of the Société Internationale de Chirurgie, Kyoto, Japan, September 3–8, 1977.     

Septic lung and shock lung in man.

Two series of patients were studied by serial measurements of blood gas exchange and pulmonarmonary dysfunction and to evaluate the dangers of respiratory failure in post traumatic patients. There were 27 patients who had sustained profound hemorrhagic shock and massive blood replacement averaging 9.7 liters and 38 patients who suffered general peritonitis or other forms of fulminating nonthoracic sepsis. All were supported by endotrachael intubation and volume controlled ventilators. The overall mortality for the post shock patients without sepsis was 12% while in the septic patients it was 35%. The maximal pulmonary arteriovenous shunt encountered in the post hemorrhagic shock patients at 36 hours averaged 20 plus or minus 8% and was accompanied by high cardiac indices (average 5.1 plus or minus 1.3 L/M-2/min) but no significant rise of pulmonary arterial pressure or peak inspiratory pressure (PIP). Severe pulmonary dysfunction subsequently occurred only in those patients who later became septic. The studies on the septic patients were divided according to the magnitude of the cardiac indices (the high indices averaged 4.8 plus or minus 1.6L/M-2/min) and thelow indices averaged 1.9 plus or minus 1.0 L/M-2/min. In the former, the average maximal shunt of 30 plus or minus 6% was sustained for 4 or more days, accompanied by an elevation of PIP to 36 plus or minus 6 cm H2O and by Pa pressure of 28 plus or minus 5 mm Hg. The patients in low output septic shock usually had an associated bronchopneumonia and had an average venous admixture of 34 plus or minus 8% and PIP values of 41 plus or minus 8 cm H2O. The mean Pa pressure in this group was 29 plus or minus 6 mm Hg.