摘要
目的通过对犬肺气肿模型施行不同体积的肺减容(LVRS)手术观察其对肺血流动力学的影响,并探讨肺减容术肺组织的最佳切除体积。方法健康杂种犬24只,随机分成4组,I组为正常对照组,II～IV组经气管注入牛胰蛋白酶后饲养6周制成犬实验肺气肿模型,其中II组用来验证模型的制备结果,III组和IV组行肺减容手术,分别予以切除肺组织重量占平均全肺总重量的20%～30%和30%～40%。术后饲养4周处死。手术前、手术后1h、手术后4周分别查动脉血气,测量平均肺动脉压(MPAP)、肺毛细血管嵌顿压(PCWP)及心排出量(CO),由以上结果计算出肺血管阻力(PVR)。结果III组手术4周后PaO2和PaCO2均明显改善(P<0.05),IV组无显著变化(P>0.05)。III组手术后1h的MPAP显著升高(P<0.05),4周后降至术前水平(P>0.05);IV组术后始终高于手术前(P<0.05)。III组手术后1h的PVR保持手术前水平(P>0.05),4周后有所下降(P<0.05);IV组则始终高于术前(P<0.05)。结论LVRS手术切除双肺总量的20%～30%是安全、有效的,适当的肺减容能够在有效地改善肺功能同时促进心脏功能的恢复。
Objective To clarify the effect of lung volume reduction surgery on pulmonary hemodynamie by operate on clog model of pulmonary emphysema and define optimal resection volumes. Methods 24 dogs were randomly divided into 2 groups. Group I, including 6 dogs served as normal control,the dogs received a single endotracheal injection of 0.9% NaCl. All other 3 groups, 18 dogs are all be injected bovine pancreatic trypsinase 3 000 IU/Kg through the bronchi. After 6 weeks the group II as emphysema control, group Ⅲ and Ⅳ received bilateral LVRS via thoractomy with a stapler, resecting 20% - 30% or 30% - 40% of whole lung volume respectively. We measured MPAP, PCWP and CO through a Swan-Ganz thermodilution catheter in groups Ⅲ and Ⅳ preoperatively, 1 hour after LVRS and at sacrifice 4 week after LVRS. Results After LVRS, the PaO2 of group Ⅲ increased and PaCO2 decreased compare with preoperative＇s, but in group Ⅳ PaO2 and PaCO2 didn＇t improved. One hour after LVRS, M-PAP elevated significantly in group Ⅲ and Ⅳ,4 week later group Ⅲ droped to baseline, and group Ⅳ didn＇t change. The postoperative PVR of group Ⅲ didn＇t increased after 1 hour , further more it dropped significandy 4 week later ; and group Ⅳ＇s postoperative PVR markedly increased. Conclusion LVRS is effective and safe, when about 20% - 30% of lung volume is resected.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2005年第4期228-230,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
