【作者】 廖东山；

【导师】 廖崇先； 李增棋； 陈道中；

【作者基本信息】 福建医科大学 ， 胸心外科， 2002， 硕士

【摘要】 目的：探讨不同热缺血时间对无心跳供体肺的结构和功能的影响，以进一步论证无心跳供体肺应用于肺移植的可能性。 方法：取30对健康Sprague-Dawley大白鼠，即供体和受体，分成3组，即有心跳供体(HBD)组、无心跳供体—热缺血30分钟(NHBD-30)组、无心跳供体—热缺血60分钟(NHBD-60)组。3组均给予气管切开，连接呼吸机辅助呼吸，吸气氧浓度50％。供体鼠处死的方法均为剪断腹主动脉放血，HBD组供体在处死的同时灌注4℃LPD液，NHBD-30组、NHBD组供体处死后维持辅助呼吸，分别放置室温中30分钟或60分钟，再灌注低钾右旋糖苷(LPD)液。供肺置于4℃LPD液中4小时，留取左肺。受体鼠切除左肺，行“原位左肺移植术”。术后维持辅助呼吸1小时，经右侧进胸，阻断右肺门，测定观测指标。 结果：1．阻断右肺门后，HBD组、NHBD-30组存活时间均超过30分钟，NHBD-60组有4只10分钟后心跳停止，3只20分钟后心跳停止。2．移植后NHBD-30组与HBD组相比，肺吸气末压、肺顺应性、LPD液灌注时间、PaO2、PaCO2、能量代谢、肺组织MPO和MDA含量、肺干／湿重比、超微结构的改变等指标的差别均无显著意义(P＞0.05)。3．移植后NHBD-60组与HBD组和NHBD-30组相比，上述指标的差别都有显著意义(P＜0.05)。 结论：热缺血30分钟的无心跳供体肺可以用于大白鼠的肺移植，其结构和功能均未发生显著的改变，热缺血60分钟的无心跳供体肺因结构破坏严重，功能基本丧失，不适于大白鼠的肺移植。更多还原

【Abstract】 Background: A shortage of lung donors pool is a serious obstacle to the widespread application of lung transplantation for end-stage lung disease. The desire of enlarging the donors pool compels us to explore the feasibility of non-heart-beating donor in rat lung transplantaion.Methods: Sixty Sprague-Dawley rats were randomly divided into 3 groups that lung of the rat were harvested immediately, 30 minutes and 60 minutes after cardiac-arrest. All the donor heparinized lungs were ventilated at the moment when they were flushed with the low potassium dextran solution and then stored in the same solution at 4 for 4 hours. The recipient animal underwent left thoracotomy, and then orthotopic left lung transplatation. The right pulmonary hilum were ligated 1 hour after reperfusion.Results: All the recipients of heart-beating lungs and 30 minutes cadaver lungs survived the observation period with excellent gas exchange, whereas 4 of 10 recipients of 60 minutes cadaver lungs survived for 10 minutes after the ligation of right pulmonary hilum and 3 for 20 minutes. The microstructure, pulmonary compliance, energy metabolism and other markers show no significant difference between HBD group and NHBD-30 group.Conclusion: The adoption non-heart-beating donor can be a safe and effective method to increase the lung donor pool. Since the ischemia-reperfusion injury shows more serious with the longer warm ischemic time, there should be a definition for the warm ischemia time, such as 30 minutes for the rat.更多还原