无心跳供体肺移植中部分液体通气对肺保护的病理学评估

背景：如何在热缺血期给予无心跳供体肺提供保护进而降低移植后原发性移植物失功能是所有研究者和临床医生面前的首要问题.目的：从病理学角度评价部分液体通气在无心跳供体肺移植中对供体肺的保护作用.方法：将36只清洁级SD大鼠随机均分为3组,应用自制16G深静脉留置针作气管插管,行气管切开并连接至呼吸机行机械通气.经颈静脉注入KACL溶液猝死大鼠,用多导生理检测仪连续记录血压,在血压变为0 mm Hg时,认为造模成功,模型建立后氧气组大鼠继续给予机械通气2 h;盐水组和氟化碳组先给予盐水和氟化碳5 min的纯氧通气,后从气管插管中注入相当于功能残气量的高氧盐水和高氧氟化碳（10 mL/kg）,并给予机械通气2 h.结果与结论：大体观察盐水组肺脏肿胀,肺组织表面片状出血,肺呈暗红色,气道内有血性水肿液;氧气组见肺脏肿胀较轻,肺表面有少量出血点;氟化碳组肺组织炎症细胞浸润和组织水肿明显减轻.光镜下盐水组和氧气组呈弥漫性肺泡和间质充血、水肿,支气管壁及毛细血管周围有大量的炎性细胞浸润和肺泡过度膨胀,肺泡壁断裂;氟化碳组肺组织细胞结构较为完整,无明显破坏.结果可见部分液体通气可以对无心跳供肺起到很好的保护作用.

Pathological assessment of part liquid ventilation in the protection of non-heart-beating donor lung

BACKGROUND： How to protect the non-heart-beating donor lung in the warm ischemia period in order to reduce the primary graft dusfunction after transplantation is the most important issue to all the researchers and clinicians. OBJECTIVE： To assess the effect of part liquid ventilation in the protection of non-heart-beating donor lung from pathology. MEHODS： Thirty-six health SD rats were randomly divided into three groups. Homemade 16G deep vein needle lien was used for endotracheal intubation and connected to a respirator machine with mechanical ventilation. The KACL solution was injected into the jugular and lead to the rat sudden death, the multi-channel physiological detector was used to continuous record the blood pressure, the model was successful when the blood pressure was 0 mmHg. After the models were established, the models in the normal mechanical ventilation group were preformed with mechanical ventilation for 2 hours; the models in the saline group and the perfluoro carbon group were given oxygen ventilation for 5 minutes, then injected with the equivalent of the functional residual capacity of the oxygen salt and high oxygen perfluoro carbons （10 mL/kg） by endotracheal intubation, and mechanical ventilation for 2 hours. RESULTS AND CONCLUSION： General observation showed that the lung of saline group was swelling, the sheet surface of lung tissue was bleeding, the lung was dark red, airway edema with bloody fluid; the lung of oxygen group was less swelling and less bleeding points of lung surface; in the perfluoro carbon group, the lung tissue inflammatory cell infiltration and edema was reduced. Light microscope observation of saline group and oxygen group showed that there was diffuse alveolar and interstitial hyperemia and edema, a large number of inflammatory cel infiltration could be seen in the bronchial wall and capillaries surrounding, the alveolar was over-expansion and the alveolar wall was ruptured; the lung tissue structure in the perfluoro carbon group was more complete and no significant damage. The results show that partial liquid ventilation can play a very good role in the protection of the non-heart-beating donor lungs.