大鼠自体原位肝移植中逆行灌注法对急性肺损伤的影响

目的探讨大鼠自体原位肝移植术中经下腔静脉逆行灌注与经门静脉顺行灌注法对急性肺损伤的影响。方法 Sprague-Dawley(SD)大鼠75只随机分成逆行灌注组、顺行灌注组、假手术组,建立大鼠自体原位肝移植逆行灌注、顺行灌注和假手术模型,各组于术后6h、12h、24h分别随机处死6只大鼠,测定肺干/湿重量比值、肺组织髓过氧化物酶(myeloperoxidase,MPO)活性、丙二醛(malondialdehyde,MDA)含量、肿瘤坏死因子(TNF)-α含量,行肺组织病理学检查。结果与假手术组比较,逆行灌注组和顺行灌注组术后肺干/湿重量比值变小,肺组织MPO活性、MDA含量、TNF-α含量增加,以术后6h与12h明显。与顺行灌注组比较,逆行灌注组术后6h、12h的肺干/湿重量比值较高,而肺组织MPO活性、MDA含量较低,差异有统计学意义(均为P<0.05);术后24h两组间在上述指标差异无统计学意义(均为P>0.05);逆行灌注组肺组织TNF-α含量在术后6h、12h、24h均显著降低,两组间差异有统计学意义(均为P<0.05)。肺组织苏木素-伊红染色:逆行灌注组、顺行灌注组均表现不同程度的肺泡结构破坏,肺泡间隔增厚,小静脉、毛细血管充血、淤血,炎症细胞浸润。其中术后6h、12h表现较重,术后24h较轻;同时显示逆行灌注组肺组织病理损伤较顺行灌注组明显减轻。结论大鼠自体原位肝移植术中用顺行灌注或逆行灌注,术后早期均存在急性肺损伤,其中术后6h和12h损伤较严重,术后24h肺损伤减轻;逆行灌注造成的急性肺损伤程度比顺行灌注要轻。     

自体原位肝移植大鼠围术期急性肺损伤的研究

目的 建立SD大鼠自体原位肝移植模型,动态观察自体原位肝移植围术期肺损伤特点.方法 选取健康SPF级SD大鼠40只,随机分为假手术对照组(S组,n=8)和模型组(M组),M组进行自体原位肝移植手术,根据肝脏再灌注时间不同再分为4个亚组.S组在麻醉后只进行开腹和血管的分离,不进行肝脏的阻断和灌注.分别在肝脏再灌注后4、8、16、24 h采集动脉血和肺组织标本,分别用于检测动脉氧分压、肺组织病理学.结果 与S组[(120.75 ±6.58) mm Hg(1 mmHg =0.133 kPa)]比较,M2组(97.50±8.22)mm Hg动脉氧分压降低(P＜0.05),其余各组差异无统计学意义(P＞0.05).M组肺组织镜下见大量的炎症细胞浸润,肺泡腔内渗出明显,肺泡腔狭窄,肺间质明显出血充血,肺泡间隔明显增厚,肺实质所占的比例显著增加;这些病理改变在M2组(肝脏再灌注8h)达到高峰,然后逐渐好转.结论 自体原位肝移植后SD大鼠存在肺损伤,在肝脏再灌注后8h达到高峰.     

线粒体型天门冬氨酸氨基转移酶在大鼠肝移植术后的变化意义

目的 探讨线粒体型天门冬氨酸氨基转移酶(m-ASI)以及m-AST与天门冬氨酸氨基转移酶(AST)比值在大鼠自体原位肝移植手术中的变化意义.方法 采用大鼠门静脉灌注的自体原位肝移植模型,A组:自体原位肝移植组;B组:正常大鼠假手术对照组.测定两组大鼠术后各时间段血清中m-AST、AST及ALT,计算出m-AST/AST...     

纯氧对脓毒症大鼠所致急性肺损伤的保护作用

目的探索纯氧通气对脓毒症大鼠所致急性肺损伤的保护作用。方法 SD大鼠采用盲肠结扎穿孔(cecal ligation and puncture,CLP)制备脓毒症模型,按照随机设计方法大鼠均分为四组:假手术+空气组(A组),假手术+纯氧组(P组),模型+空气组(C组),模型+纯氧组(O组)。P组与O组动物在手术后6h持续吸入纯氧2h,A组与C组动物则给予自由呼吸空气。评估术后24h肺的组织学形态及组织学评分,肺干湿比、支气管灌洗液(bronchial alveolar lavage fluid,BALF)中总蛋白和白蛋白含量、肺组织匀浆髓过氧化物酶(myeloperoxidase,MPO)活性等肺损伤指标,以及动脉血气分析。记录大鼠手术后7d生存率。结果 A组和D组术后7d内生存率均为100%。与A组和P组比较,C组术后7d生存率明显降低(P0.01),且肺部组织学形态改变明显(P0.01);肺损伤指标明显升高(P0.01);pH、PaO2、PaO2/FiO2水平明显下降(P0.01),PaCO2、血乳酸水平明显升高(P0.01);O组术后7d生存率明显降低(P0.05),肺组织病理也有损伤,且病理学评分轻微升高(P0.05),但肺损伤指标差异无统计学意义,动脉血气分析仅血乳酸水平明显升高(P0.05)。与C组比较,O组术后7d生存率明显升高(P0.05);肺组织病理改变改善,病理学评分、肺损伤指标、PaCO2明显降低(P0.01);pH、PaO2、PaO2/FiO2水平明显升高(P0.01)。结论本实验证实了纯氧对脓毒症大鼠所致急性肺损伤具有改善作用。     

MMP-9高表达在大鼠重症急性胰腺炎急性肺损伤中的作用

目的 观察基质金属蛋白酶-9在大鼠重症急性胰腺炎急性肺损伤早期发病中的表达规律,并探讨其对肺损伤的影响.方法 健康成年雄性SD大鼠32只,随机分为对照组和重症急性胰腺炎3h、6h、12 h组,每组各8只,胰胆管逆行注入牛磺胆酸钠法,建立重症急性胰腺炎肺损伤大鼠模型.重症急性胰腺炎组分别在建模后3h、6h、12 h检测大鼠动脉血气、肺组织含水率、肺髓过氧化物酶活性,肺组织基质金属蛋白酶-9活性,光镜下进行胰腺和肺病理损伤评分.免疫组化法检测基质金属蛋白酶-9的表达,结果应用Image-Pro Plus专业图像分析系统定量分析.对照组在术后12 h检测上述相关指标.结果 造模成功后,3h肺组织基质金属蛋白酶-9开始逐渐升高,并于12 h达最高(P＜0.05);肺损伤程度逐渐加重,肺组织含水率、髓过氧化物酶活性、PaC02逐渐升高(P＜0.05),PaO2明显降低(P＜0.05).结论 基质金属蛋白酶-9高表达是重症急性胰腺炎早期并发急性肺损伤的重要发病机制之一.     

亚甲蓝预处理对大鼠肝缺血再灌注肺损伤的保护作用

目的研究肝缺血再灌注后肺损伤的机制以及亚甲蓝的保护作用。方法 36只SD大鼠随机分为假手术组（S组,n=12）、缺血再灌注组（I/R组,n=12）和亚甲蓝处理组（MB组,n=12）。阻断肝门30分钟后开放血流,建立大鼠全肝缺血再灌注模型。I/R组与MB组分别于肝门阻断前10分钟腹腔注射亚甲蓝10mg/kg或相应剂量生理盐水,于再灌注1小时取血、处死动物。假手术组不阻断肝门,于上述相应时间点注射生理盐水与取血、处死动物。肝肺病理切片光镜观察、肺干湿重比、肺组织丙二醛（MDA）含量、髓过氧化物酶（MPO）活力、血清TNF-α和IL-8含量。结果病理结果显示,亚甲蓝组缺血再灌注后肺损害程度较缺血再灌注组减轻。缺血再灌注组较假手术组肺组织干湿重比、MDA含量、MPO活性和血清TNF-α和IL-8含量升高（P〈0.01）,而亚甲蓝组较缺血再灌注组肺组织干湿重比和血清TNF-α和IL-8含量（P〈0.01）,MDA含量和MPO活性（P〈0.05）均有下降。结论肝缺血再灌注会导致肺损伤,缺血前给予亚甲蓝对大鼠肝I/R后肺损伤具有有保护作用。     

姜黄素对肝缺血再灌注损伤保护作用的研究

目的探讨姜黄素对自体肝移植大鼠肝脏缺血再灌注损伤(IRI)的保护作用及其可能机制。方法54只SD雄性大鼠随机分为假手术(SO)组、自体肝移植模型姜黄素预处理(CU)组以及自体肝移植模型溶剂对照(CM)组,术后或再灌注2,6,24 h每组分别处死6只大鼠进行谷丙转氨酶(ALT)、谷草转氨酶(AST)、髓过氧化物酶(Myeloperoxidase MPO)的含量检测。结果血清ALT及AST水平,CM组及CU组均较SO组明显升高,但CM组又明显高于CU组;MPO在SO组含量明显低于CM组和CU组,而CU组又显著低于CM组。结论姜黄素对自体肝移植大鼠肝缺血再灌注损伤有保护作用,其机制可能与减轻中性粒细胞浸润有关。     

自体原位肝移植逆行灌注法对大鼠急性肾损伤的影响

目的探讨自体原位肝移植术中经下腔静脉逆行灌注对大鼠肾功能的影响,为临床肝移植应用经下腔静脉逆行灌注法提供实验依据。方法 60只自体原位肝移植大鼠随机分为逆行灌注组、门静脉灌注组与假手术组各20只。前两组建立自体肝移植模型,其中逆行灌注组采用经下腔静脉逆行灌注法,先开放下腔静脉,再开放门静脉,最后开放肝动脉。门静脉灌注组采用常规经门静脉正向灌注法,先开放门静脉,再开放下腔静脉,最后开放肝动脉。假手术组开腹后游离肝门处门静脉、肝动脉及肝上、下下腔静脉,不予阻断,17min后关腹。分别检测3组术前1h、术后1h、8h及术后1d、5d的血清肌酐(Scr)、血尿素氮(BUN)水平;无肝期结束后1h、8h、1d取左肾组织行光镜检查观察肾组织病理形态学变化。结果术前1h,各组肾功能指标比较差异均无统计学意义(均为P>0.05);与假手术组比较,逆行灌注组、门静脉灌注组术后1h、8h及1d的Scr、BUN水平显著增高,而且逆行灌注组上述两指标明显低于门静脉灌注组(均为P<0.05),但术后5d3组比较差异均无统计学意义(均为P>0.05)。无肝期结束后1h,逆行灌注组和门静脉灌注组肾组织病理学检查发现肾间质充血,8h出现明显的肾小管上皮细胞水肿及肾间质充血,逆行灌注组明显轻于门静脉灌注组;无肝期结束后1d两组肾组织损伤呈现好转趋势,且逆行灌注组明显优于门静脉灌注组。结论自体原位肝移植术中实施逆行灌注可减轻大鼠急性肾损伤,改善大鼠早期肾功能。     

用于再灌注损伤研究的两种肝移植模型的筛选

目的:筛选一种用于研究肝移植过程中缺血再灌注损伤的大鼠肝移植模型.方法:将SD大鼠随机分为假手术组(S组)、原位肝移植组(OLT组)与自体肝移植组(AT组).比较各组大鼠手术时间、存活率及术后24 h血清中总胆红素(TB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)及血清肿瘤坏死因子-α(TNF-α)含量,观察肝组织形态学改变.结果:与S组相比OLT组、AT组术后血清TB、ALT、AST升高明显,AT组较OLT组术后存活率明显提高,血清TB、ALT、AST及TNF-α含量明显降低,肝形态异常变化减轻(P<0.05).结论:自体肝移植模型手术简单、成功率高、可比性强,且排除了免疫损伤的影响,更好地反映了肝脏缺血再灌注损伤的病理生理过程,比较适宜作为肝移植缺血再灌注损伤研究的动物模型.     

逆灌注法对大鼠移植肝氧化应激和炎性反应的影响

目的:通过建立大鼠同种异体原位肝移植模型,观察逆灌注法对移植肝氧化应激和炎性反应的影响。方法:将120只大鼠按照随机数字表法分为正灌注对照组(IPR组)和逆灌注实验组(RETR组),各60只,分别行正灌注、逆灌注法原位肝移植术,分别于再灌注后1、2、6 h检测大鼠血清测肿瘤坏死因子-α(TNF-α)、高迁移率族蛋白B1...     

盐酸戊乙奎醚对大鼠胸部撞击致急性肺损伤及肺组织Toll样受体4表达的影响

目的 探讨盐酸戊乙奎醚对大鼠胸部撞击致急性肺损伤及肺组织Toll样受体4(TLR4)表达的影响.方法 健康雄性SD大鼠96只,体重250～300 g,采用随机数字表法,将大鼠随机分为3组(n=32):对照组(C组)只麻醉,不制备模型;肺损伤组(ALI组);盐酸戊乙奎醚组(PHcD组)模型制备后即刻,腹腔注射盐酸戊乙奎醚2 mg/kg.砝码(300g)于95 cm高处自由落体撞击大鼠心前区以制备急性肺损伤模型.于模型制备后2、8、12和24h时取8只大鼠,取动脉血样,测定血清TNF-α浓度.于模型制备后8 h取8只大鼠,取动脉血样,行动脉血气分析,随后处死大鼠,取肺组织观察病理学结果,测定干/湿重比(W/D比)、髓过氧化物酶(MPO)活性和TLR4表达水平.结果 与c组比较,ALI组和PHCD组pH值和PaO2下降,PaCO2、乳酸浓度、肺组织MPO活性、W/D比及TLR4表达和血清TNF-α浓度升高(P＜0.01);与ALI组比较,PHcD组pH值和PaO2升高,PaCO2、乳酸浓度、肺组织MPO活性、W/D比及TLR4表达和血清TNF-α浓度降低(P＜0.05).PHcD组肺组织病理性损伤较ALI组减轻.结论 盐酸戊乙奎醚可减轻大鼠胸部撞击诱发的急性肺损伤,其机制与下调肺组织TLR4表达,降低炎性反应有关.

Abstract：

Objective To investigate the effects of penehyclidine hydrochloride (PHCD) on acute lung injury (ALI) induced by blunt chest trauma and Toll-like receptor 4 (TLR4) expression in the lung tissues in rats.Methods Ninety-six male SD rats weighing 250-300 g were randomly divided into 3 groups ( n = 32 each):control group (group C), ALI group and PHCD group. ALI was induced by dropping a 300 g weight onto a precordial protective shield to direct the impact force away from the heart and toward the lungs in anesthetized rats according to the method described by Raghavendran et al. PHCD 2 mg/kg was injected intraperitoneally immediately after ALI was induced in group PHCD. Eight rats were selected at 2, 8, 12 and 24 h after ALI was induced, and arterial blood samples were collected for determination of the serum TNF-α concentration. Eight rats were selected at 8 h after ALI was induced, arterial blood samples collected for blood gas analysis and then the rats sacrificed. The lungs were immediately removed for determination of W/D lung weight ratio, myeloperoxidase (MPO) activity and TLR4 expression, and microscopic examination. Results The pH value and PaO2 were significantly lower, and the PaCO2, lactic acid level, MPO activity, W/D ratio, TLR4 expression and serum TNF-α concentration higher in groups ALI and PHCD than in group C (P ＜ 0.01 ). The pH value and PaO2 were significantly higher, and the PaCO2, lactic acid level, MPO activity, W/D ratio, TLR4 expression and serum TNF-α concentration lower in group PHCD than in group ALI ( P ＜ 0.05). The lung histopathologic damage was significantly ameliorated in PHCD group as compared with ALI group. Conclusion PHCD can protect the lungs against blunt chest trauma-induced ALI, and the down-regulation of TLR4 expression in lung tissues and reduction of inflammatory response are involved in the mechanism.     

脑死亡供体鼠吸入一氧化碳对受体鼠移植肺损伤的影响

目的 评价脑死亡供体鼠吸入一氧化碳(CO)对受体鼠移植肺损伤的影响.方法 雄性Wistar大鼠24只,体重250～300 g,随机分为3组(n=8),接受非脑死亡供体肺组(NBD组)供体鼠颅内置入Fogarty导管,但不诱导脑死亡,观察2.5 h;接受吸入氧气的脑死亡供体肺组(BDO2组)供体鼠确认脑死亡后吸入40%氧气2 h;接受吸入CO的脑死亡供体肺组(BDCO组)供体鼠确认脑死亡后吸入40%氧气和0.025%CO混合气2 h.处理结束后取供体左肺,进行原位异体肺移植,受体鼠每30 min进行一次动脉血气分析.肺移植成功后2 h处死受体鼠,采集右股动脉血样,采用嘌呤氧化酶法测定血浆超氧化物歧化酶(SOD)活性;采用硫代巴比妥酸法测定丙二醛(MDA)浓度;采用ELISA法测定血浆白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α和IL-10浓度.计算移植肺组织湿/干重比(W/D);测定移植肺组织髓过氧化物酶(MPO)活性,并进行移植肺组织损伤评分.结果 与C组比较,BDO2组和BDCO组PaO2/FiO2、BE、pH值和血浆SOD活性、IL-10浓度降低,移植肺组织W/D、MPO活性、损伤评分和血浆MDA、IL-6、TNF-α浓度升高(P<0.05);与BD02组比较,BDCO组PaO2/FiO2、BE、pH值和血浆SOD活性、IL-10浓度升高,移植肺组织W/D、MPO活性、损伤评分和血浆MDA、IL-6、TNF-α浓度降低(P<0.05).结论 脑死亡供体鼠吸入CO 2 h可减轻受体鼠移植肺损伤,其机制可能是吸入CO提高了移植肺的抗氧化能力,减轻了移植后局部和全身炎性反应.     

Pulmonary oedema in isolated lung lobe after inhalation injury

Pulmonary oedema was produced in isolated lung lobes with steam and provided direct continuous measurements of transudation as it occurred. Transvascular flux (Q_f) and weight gain (G_w) of the lobe increased immediately and the transudation reached its peak within half an hour after inhalation injury. Studies of protein content, colloid osmotic pressure of bronchial exudate and water content of lung, reconfirmed the increase in pulmonary capillary permeability. Marked haemoconcentration was revealed. Plasma leaked 113g (25 per cent), plasma protein leaked 1.96g (9.7 per cent) during the experiment. Based on the measured arterial pressure (P_a), vein pressure (P_v), arterial occlusion (P_ao), venous occlusion (P_vo), double occlusion (P_do) and blood flow through the lobe (Q_t), the total vascular (R_t), arterial (R_a), middle compartment (R_mid) and venous (R_v) resistances were calculated. All the resistances were increased and the Q_t showed a decrease after inhalation injury.     

腺病毒介导TGF-β 1转基因联合FTY720对大鼠同种异体肺移植缺血-再灌注损伤的保护作用

目的观察腺病毒介导TGF-β₁转基因联合FTY720对大鼠同种异体肺移植缺血-再灌注损伤(IRI)的影响。 方法采用改良的三袖套法吻合技术建立大鼠左肺原位移植模型。以SD大鼠为供受体,随机分为假手术对照组、空白对照组、空载体对照组、TGF-β₁组、FTY720组和TGF-β₁＋FTY720组,每组6只。移植肺再灌注后4 h,检测各项生理指标。 结果腺病毒介导TGF-β₁转基因组荧光现象显著,并确定1×10¹⁰ PFU TGF-β₁基因腺病毒载体为较优转染浓度。肺移植再灌注后4 h,与假手术对照组比较,空白对照组和空载体对照组出现典型的移植肺IRI症状,肺动脉血氧分压(PaO₂)明显降低,二氧化碳分压(PaCO₂)和湿/干重(W/D)比值明显升高,超氧化物歧化酶(SOD)活性明显降低,丙二醛(MDA)含量、髓过氧化物酶(MPO)活性和肿瘤坏死因子-α(TNF-α)含量明显升高。与空白对照组和空载体对照组比较,TGF-β₁组、FTY720组和TGF-β₁＋FTY720组移植肺组织水肿和间质炎症等病理组织学现象明显减轻,PaO₂明显上升,PaCO₂和W/D比值明显下降,SOD活性明显增加,MDA含量、MPO活性和TNF-α含量明显降低。其中,联合处理组病理症状表现出更为明显的减轻趋势。 结论腺病毒介导TGF-β₁转基因联合FTY720能有效减轻大鼠同种异体肺移植IRI。     

Improved lung function by means of retrograde flush in canine lung transplantation with non-heart-beating donors

OBJECTIVE: Use of lungs from non-heart-beating donors would increase the pulmonary donor pool. The aim of this study was to evaluate the effects of retrograde flush in canine lung transplantation from non-heart-beating donors. METHODS: Left lung transplantation was performed in 12 weight-matched pairs of dogs. Donors were killed without heparinization, left at room temperature for 2 hours, and then randomized into 2 groups. In group AF (n = 6) lung retrieval was performed after flushing the lung block with low potassium dextran glucose (50 mL/kg) solution through the pulmonary artery. In group AF+RF (n = 6) additional retrograde flushing (low potassium dextran glucose, 25 mL/kg) was performed through the left atrium before retrieval. Flushed solution was sampled at intervals to measure hemoglobin concentrations. The lungs were preserved at 4 degrees C for 2 hours, and the left lung was implanted to the recipient being subjected to a total ischemic time of 5 hours. After left lung transplantation, the right pulmonary artery and main bronchus were ligated. Lung function, including arterial blood gas and pulmonary hemodynamics, was measured for 3 hours. For lung function study, statistical analyses were performed by using 1-way analysis of variance with repeated measures. RESULTS: Group AF+RF had significantly better gas exchange and lower wet/dry weight ratio of the transplanted lung than group AF. Changes of hemoglobin concentration in the flushed solution indicated that additional retrograde flush could remove residual microthrombi after antegrade flush. CONCLUSIONS: This study supports the theory that additional retrograde flush improves lung function after lung transplantation by removing residual pulmonary microthrombi in the lungs of non-heart-beating donors.     

大鼠自体肝移植后胰腺损伤的研究

目的 探讨大鼠自体肝移植后胰腺损伤的原因.方法 42只SD大鼠按随机数字表法分为自体肝移植1、6、12、24、48、72 h组和假手术组(每组各6只).假手术组在术后立即取样,自体肝移植各组分别在术后1、6、12、24、48、72 h取样.测定血清淀粉酶、脂肪酶,了解胰腺外分泌功能;光镜、电镜观察胰腺组织形态学改变情况.采用单因素方差分析检验结果.结果 自体肝移植1 h组的大鼠血清淀粉酶、脂肪酶含量高于假手术组,随着术后时间的延长,其含量逐渐增加,自体肝移植48 h组的大鼠血清淀粉酶、脂肪酶含量达到高峰,随后下降.各组比较差异有统计学意义(F=538.622,489.417,P<0.05).光镜下,自体肝移植1 h组大鼠胰腺组织有水肿型胰腺炎的表现,自体肝移植6 h组大鼠胰腺组织有出血坏死型胰腺炎的表现,自体肝移植48 h组大鼠胰腺组织达到损伤高峰.电镜下,自体肝移植1 h组大鼠胰腺细胞出现线粒体增多、肿胀,内质网、高尔基体肿胀,线粒体的面积、周长、比表面、线粒体平均灰度值分别为(312±40)mm~2、(80.3±3.8)mm、0.332±0.039、113±11.随着时间延长,损伤逐渐加重,出现自噬体.自体肝移植48 h组大鼠胰腺细胞达到损伤高峰,其线粒体的面积、周长、比表面、平均灰度值分别达到(466±7)mm~2、(108.8±3.7)mm、0.298±0.009、195±12.各组线粒体比表面和平均灰度值比较差异有统计学意义(F=9.322,76.560,P<0.05).结论 大鼠自体肝移植后胰腺损伤与缺氧引起细胞能量代谢有关.     

IL-10改善心脏死亡大鼠离体肺灌注后供肺功能的实验研究

目的  探讨白细胞介素(IL)-10对心脏死亡大鼠离体肺灌注(EVLP)后供肺功能的影响。方法  将20只成年雄性SD大鼠随机分成单纯灌注组(A组)和改良灌注组(B组),每组10只。A组采用A灌注液(灌注液未添加IL-10)进行灌注,B组采用B灌注液(灌注液中添加IL-10)进行灌注,建立大鼠心脏死亡供肺EVLP模型。比较两组供肺外观及供肺组织干重/湿重(D/W)比值、供肺功能和代谢状态、供肺形态学表现和供肺炎症标志物水平。结果  灌注结束后,A组供肺全肺明显水肿,顺应性差,气道内涌出大量水肿液,而B组未见明显水肿,顺应性较好。与A组比较,B组肺组织D/W比值较高(P < 0.05)。两组肺静脉血氧分压均在灌注2 h时达到最高,组间比较差异无统计学意义(P > 0.05)。与A组比较,B组肺动脉压升高速度较慢,灌注结束时肺动脉压较低; 且灌注液中乳酸水平下降(均为P < 0.05)。A组肺泡结构大量破坏,细胞数量稀少,B组肺泡结构相对正常,未见明显细胞水肿。A组供肺细胞凋亡较多,B组供肺未见明显细胞凋亡现象。两组灌注4 h后单核细胞趋化蛋白(MCP)-1、IL-6水平均升高,IL-4均降低(均为P < 0.05),肿瘤坏死因子(TNF)-α、IL-1α和诱导型一氧化氮合酶(iNOS)变化无统计学意义(均为P > 0.05)。结论  IL-10可通过减少细胞凋亡改善心脏死亡大鼠EVLP后供肺的功能。     

Anterograde versus retrograde isolated lung perfusion with melphalan in the WAG-Rij rat

Objective: Isolated lung perfusion (ILuP) is an experimental technique currently tested to increase the 5-year survival of 40% after surgical resection of pulmonary metastases from certain solid tumors. The standard technique of anterograde perfusion was compared with retrograde isolated lung perfusion in which the drug is introduced through the pulmonary veins while the effluent is collected from the pulmonary artery. Since the lung has a dual arterial circulation through the pulmonary artery and bronchial circulation, perfusion through the pulmonary veins can result in a more homogeneous distribution throughout the lung with subsequent higher melphalan concentration. Methods: We randomized 20 rats into two groups. Group one underwent anterograde isolated left lung perfusion while group two underwent retrograde isolated left lung perfusion. A dose of 2 mg/kg melphalan (MN) was administered to the lung at a flow of 0.5 mL/min during 30 min, followed by a 5-min washout with buffered hetastarch (BHE). The final melphalan lung concentration (FMLC) was determined in the hilum, at the apex, the mid-periphery and the base of the lung. Statistical analysis was done with an unpaired student's t-test. Results: Retrograde left ILuP resulted in a higher FMLC in the hilum (P<0.0001) and in the base of the lung (P=0.03), while anterograde ILuP induced a higher concentration at the apex of the lung (P=0.04). No difference was seen in the mid-peripheral area of the lung (P=0.92). Conclusions: In this experimental study, retrograde perfusion seems to increase final melphalan lung concentration in hilar and basal regions of the lung compared to anterograde perfusion.