• 上海交通大學(xué)醫(yī)學(xué)院新華醫(yī)院 上海兒童醫(yī)學(xué)中心 心胸外科, 上海? 200127;

目的 探討以全氟化碳(perfluorocarbon, PFC)為媒介的部分液體通氣(partial liquid ventilation,PLV)結(jié)合持續(xù)肺動(dòng)脈灌注(continuous pulmonary perfusion, CPP)對(duì)體外循環(huán)(cardiopulmonary bypass, CPB)后幼豬急性肺損傷(acute lung injury,ALI)的肺組織炎性變化及氣體交換的影響。 方法 將18只幼豬(體重為10.2±1.6kg)隨機(jī)分為3組，對(duì)照組即單純CPB組：只行單純CPB; CPP+CPB組(CPP組):在主動(dòng)脈阻斷期間,以20～25ml/kg·min的血液流量持續(xù)灌注肺動(dòng)脈；PLV+CPP+CPB組(PLV組):在CPP組基礎(chǔ)上停CPB后即刻向肺內(nèi)灌入12ml/kg的PFC。分別在CPB前、停CPB即刻及停CPB后1h、2h、3h觀(guān)察動(dòng)脈血?dú)庵笜?biāo)的變化;實(shí)驗(yàn)結(jié)束后,取不同部位肺組織標(biāo)本于光學(xué)顯微鏡下觀(guān)察組織病理的變化。 結(jié)果 與對(duì)照組比較，PLV組在1h、2h、3h時(shí)點(diǎn)動(dòng)脈血氧分壓(PaO2)明顯升高，動(dòng)脈-肺泡氧分壓梯度(AaDO2)明顯降低(P lt;0.05), 3h時(shí)動(dòng)脈血二氧化碳分壓(PaCO2)下降顯著(P lt;005);CPP組的通氣、換氣功能也有明顯改善;PLV組保護(hù)作用則較為明顯。停CPB后，3組血液中的腫瘤壞死因子-α(TNF-α)、白細(xì)胞介素-8(IL-8)和白細(xì)胞介素-6(IL-6)均有所增加;與對(duì)照組比較，PLV組3h后TNF-α顯著降低(P lt;0.05)。組織學(xué)檢查:光學(xué)顯微鏡下見(jiàn)對(duì)照組肺組織(HE染色)細(xì)胞間黏附因子-1(ICAM-1)表達(dá)呈強(qiáng)陽(yáng)性，PLV組及CPP組均呈弱陽(yáng)性。 結(jié)論 以PFC為媒介的PLV結(jié)合持續(xù)肺動(dòng)脈灌注介入CPB誘導(dǎo)的急性肺損傷,可明顯地降低肺組織炎癥反應(yīng)和改善其肺氣體交換。

引用本文： 謝業(yè)偉,鄭景浩,徐志偉等. 全氟化碳對(duì)體外循環(huán)肺損傷保護(hù)的實(shí)驗(yàn)研究. 中國(guó)胸心血管外科臨床雜志, 2007, 14(6): 438-. doi: 復(fù)制

1. 　Ng CS, Wan S, Yim AP,et al. Pulmonary dysfunction after cardiac surgery.Chest, 2002,121(4):1269-1277.
2. 　Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002,21(2):232-244.
3. 　Pintar T,Collard CD.The systemic inflammatory response to cardiopulmonary bypass. Anesthesiol Clin North America,2003, 21(3):453-464.
4. 　Zobel G, Rdl S, Urlesberger B, et al. Partial liquid ventilation combined with two different gas ventilatory strategies in acute lung injury in piglets: Effects on gas exchange, respiratory mechanics, and hemodynamics. J Pediatr Surg, 2003, 38(4):527-533.
5. 　Cheifetz IM,Cannon ML,Craig DM, et al. Liquid ventilation improves pulmonary function and cardiac output in a neonatal swine model of cardiopulmonary bypass. J Thorac Cardiovascular Surg,1998,115(3):528-535.
6. 　Davies MW, Sargent PH. Partial liquid ventilation for the prevention of mortality and morbidity in paediatric acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev, 2004,2:CD003845.
7. 　Nugent LJ, Mazzoni MC, Flaim SF, et al.Dose maintenance for partial liquid ventilation: passive heat-and-moisture exchanges. Biomed Instrum Technol, 1999, 33 (4) :365-372.
8. 　Nakamura T, Tamura M.Partial liquid ventilation with low dose of perflubron and a low stretch ventilation strategy improves oxygenation in a rabbit model of surfactant depletion. Biol Neonate, 2002, 82(1):66-69.
9. 　Thome UH,Schulze A,Schnabel R, et al. Partial liquid ventilation in severely surfactant-depleted,spontaneously breathing rabbits supported by proportional assist ventilation. Crit Care Med, 2001,29(6):1175-1180.
10. 　Huang H, Yao T, Wang W, et al.Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery. Chin Med J (Engl), 2003, 116(10):1504-1507.
11. 　Abraham E.Neutrophils and acute lung injury.Crit Care Med, 2003,31(4 Suppl):S195-S199.
12. 　Jensen E, Bengtsson A,Berggren H, et al.Clinical variables and pro-inflammatory activation in paediatric heart surgery. Scand Cardiovasc J, 2001,35(3):201-206.
13. 　Asimakopoulos G, Smith PL, Ratnatunga CP,et al. Lung injury andacute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg,1999,68 (3) :1107-1115.
14. 　Haeberle HA, Nesti F, Diet rich HJ, et al.Perflubron reduces lung inflammation in respiratory syncytial virus infection by inhibiting chemokine expression and nuclear factor-kappa B activation.Am J Respir Crit Care Med, 2002,165(10):1433-1438.
15. 　Koch T, Ragaller M, Haufe D, et al. Perfluorohexane attenuates proinflammatory and procoagulatory response of activated monocytes and alveolar macrophages. Anesthesiology,2001, 94(1):101-109.
16. 　Schroeder S, Brger N, Wrigge H, et al. A tumor necrosis factor gene polymorphism influences the inflammatory response after cardiac operation. Ann Thorac Surg, 2003,75(2):534-537.
17. 　Decleva E, Dri P, Menegazzi R, et al. Evidence that TNF-induced respiratory burst of adherent PMN is mediated by integrin alpha(L) beta (2).J Leukoc Biol, 2002,72(4):718-726.
18. 　Maianski NA, Roos D, Kuijpers TW. Tumor necrosis factor alpha induces a caspase independent death pathway in human neutrophils. Blood, 2003, 101(5):1987-1995.
19. 　Hill GE, Whitten CW, Landers DF. The influence of cardiopulmonary bypass on cytokines and cell-cell commu-nication. J Cardiothorac Vasc Anesth, 1997,11(3):367-375.
20. 　Zheng JH, Xu ZW, Wang W, et al. Lung perfusion with oxygenated blood during aortic clamping prevents lung injury. Asian Cardiovasc Thorac Ann, 2004,12(1):58-60.
21. 　Liu Y, Wang Q, Zhu X, et al. Pulmonary artery perfusion with protective solution reduces lung injury after cardiopulmonary bypass.Ann Thorac Surg, 2000, 69(5):1402-1407.
22. 　von der Hardt K, Schoof E,Kandler MA,et al. Aerosolized perfluorocarbon suppresses early pulmonary inflasmmatory response in a surfactant-depleted piglet model.Pediatrc Res,2002,51(2):177-182.
  1. 1. 　Ng CS, Wan S, Yim AP,et al. Pulmonary dysfunction after cardiac surgery.Chest, 2002,121(4):1269-1277.
  2. 2. 　Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002,21(2):232-244.
  3. 3. 　Pintar T,Collard CD.The systemic inflammatory response to cardiopulmonary bypass. Anesthesiol Clin North America,2003, 21(3):453-464.
  4. 4. 　Zobel G, Rdl S, Urlesberger B, et al. Partial liquid ventilation combined with two different gas ventilatory strategies in acute lung injury in piglets: Effects on gas exchange, respiratory mechanics, and hemodynamics. J Pediatr Surg, 2003, 38(4):527-533.
  5. 5. 　Cheifetz IM,Cannon ML,Craig DM, et al. Liquid ventilation improves pulmonary function and cardiac output in a neonatal swine model of cardiopulmonary bypass. J Thorac Cardiovascular Surg,1998,115(3):528-535.
  6. 6. 　Davies MW, Sargent PH. Partial liquid ventilation for the prevention of mortality and morbidity in paediatric acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev, 2004,2:CD003845.
  7. 7. 　Nugent LJ, Mazzoni MC, Flaim SF, et al.Dose maintenance for partial liquid ventilation: passive heat-and-moisture exchanges. Biomed Instrum Technol, 1999, 33 (4) :365-372.
  8. 8. 　Nakamura T, Tamura M.Partial liquid ventilation with low dose of perflubron and a low stretch ventilation strategy improves oxygenation in a rabbit model of surfactant depletion. Biol Neonate, 2002, 82(1):66-69.
  9. 9. 　Thome UH,Schulze A,Schnabel R, et al. Partial liquid ventilation in severely surfactant-depleted,spontaneously breathing rabbits supported by proportional assist ventilation. Crit Care Med, 2001,29(6):1175-1180.
  10. 10. 　Huang H, Yao T, Wang W, et al.Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery. Chin Med J (Engl), 2003, 116(10):1504-1507.
  11. 11. 　Abraham E.Neutrophils and acute lung injury.Crit Care Med, 2003,31(4 Suppl):S195-S199.
  12. 12. 　Jensen E, Bengtsson A,Berggren H, et al.Clinical variables and pro-inflammatory activation in paediatric heart surgery. Scand Cardiovasc J, 2001,35(3):201-206.
  13. 13. 　Asimakopoulos G, Smith PL, Ratnatunga CP,et al. Lung injury andacute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg,1999,68 (3) :1107-1115.
  14. 14. 　Haeberle HA, Nesti F, Diet rich HJ, et al.Perflubron reduces lung inflammation in respiratory syncytial virus infection by inhibiting chemokine expression and nuclear factor-kappa B activation.Am J Respir Crit Care Med, 2002,165(10):1433-1438.
  15. 15. 　Koch T, Ragaller M, Haufe D, et al. Perfluorohexane attenuates proinflammatory and procoagulatory response of activated monocytes and alveolar macrophages. Anesthesiology,2001, 94(1):101-109.
  16. 16. 　Schroeder S, Brger N, Wrigge H, et al. A tumor necrosis factor gene polymorphism influences the inflammatory response after cardiac operation. Ann Thorac Surg, 2003,75(2):534-537.
  17. 17. 　Decleva E, Dri P, Menegazzi R, et al. Evidence that TNF-induced respiratory burst of adherent PMN is mediated by integrin alpha(L) beta (2).J Leukoc Biol, 2002,72(4):718-726.
  18. 18. 　Maianski NA, Roos D, Kuijpers TW. Tumor necrosis factor alpha induces a caspase independent death pathway in human neutrophils. Blood, 2003, 101(5):1987-1995.
  19. 19. 　Hill GE, Whitten CW, Landers DF. The influence of cardiopulmonary bypass on cytokines and cell-cell commu-nication. J Cardiothorac Vasc Anesth, 1997,11(3):367-375.
  20. 20. 　Zheng JH, Xu ZW, Wang W, et al. Lung perfusion with oxygenated blood during aortic clamping prevents lung injury. Asian Cardiovasc Thorac Ann, 2004,12(1):58-60.
  21. 21. 　Liu Y, Wang Q, Zhu X, et al. Pulmonary artery perfusion with protective solution reduces lung injury after cardiopulmonary bypass.Ann Thorac Surg, 2000, 69(5):1402-1407.
  22. 22. 　von der Hardt K, Schoof E,Kandler MA,et al. Aerosolized perfluorocarbon suppresses early pulmonary inflasmmatory response in a surfactant-depleted piglet model.Pediatrc Res,2002,51(2):177-182.