支气管堵塞肺减容术治疗慢性阻塞性肺疾病疗效实验研究

目的 探讨支气管堵塞肺减容术(bronchoscopic lung volume reduction, BLVR)对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的疗效.方法 建立15只犬COPD模型,按随机抽样方法分为3组,A组为肺气肿对照组,B组为单向阀植入组,C组为蛋白胶堵塞组.采集数据于模型建立前、模型建立后6周、肺减容后6周进行,对各组通气、血流动力学数据及通气灌注扫描结果数据比较,评价.结果 BLVR后B组PaO2升高,PaCO2下降(P＜0.05);B、C 2组肺动脉压力无变化(P＞0.05),肺顺应性增加(P＜0.05),手术区肺通气、灌注CTS/PIX均显著下降(P＜0.01,P＜0.05),且与对照组比较差异有统计学意义(P＜0.05).病理学证实术后靶区肺组织有肺泡萎陷、实变、间质结缔组织增生等改变.结论 单侧BLVR术后肺功能较术前改善.手术靶区通气血流均减少,通气血流比例下降.全肺循环未受影响,血流重分布,有利于肺功能改善.

Experimental study on the therapeutic effects of bronchoscopic lung volume reduction on COPD

Objective To evaluate the curative effects of bronchoscopic lung volume reduction(BLVR) onchronic obstructive pulmonary disease(COPD).Methods The COPD models were established in 15 dogs. The dogswere randomly divided into 3 groups,5 dogs in each group.Group A was control group;group B underwent endobronchial valve implantation(EVI);group C underwent bronchial blocking with albumin gel.Data collection was made before the models were set up,6 weeks after models were made and 6 weeks after BLVR.The data including ventilation/perfusion redistribution,nuclear ventilation/perfusion scan were statistically analyzed and compared.Results There was a significant improvement in PaO2 and PaCO2 in group B 6 weeks after BLVR(P<0.05),however,there was no significant difference in the pressure of lung artery in group B and group C(P>0.05).The compliance of lungs obviously increased(P<0.05),but the lung ventilation and perfusion CTS/PIX was significantly decreased(P<0.01 or P<0.05).The lung collapse,solidification and proliferation interstitial connective tissue were found by pathological examination.Conclusion Pulmonary function after unilateral BLVR improves obviously,as compared with that before operation.Both ventilation and perfusion reduce,and the ratio of V/Q decreases.But general lung circulation is not influenced,and blood flow could redistribute,as a result,lung function could be improved.