單側(cè)經(jīng)支氣管鏡肺減容對(duì)COPD對(duì)COPD犬通氣血流影響的實(shí)驗(yàn)研究

1、單側(cè)經(jīng)支氣管鏡肺減容對(duì)COPD對(duì)COPD犬通氣血流影響的實(shí)驗(yàn)研究首都醫(yī)科大學(xué)附屬北京朝陽(yáng)醫(yī)院 100020 王暉 岳云目的：建立非均質(zhì)型肺氣腫模型犬，并實(shí)施單側(cè)經(jīng)支氣管鏡肺減容術(shù)（BLVR）。通過(guò)對(duì)比觀察術(shù)前后通氣血流變化、血液氣體分析、呼吸力學(xué)及循環(huán)動(dòng)力學(xué)改變、CT影像及病理組織學(xué)變化，了解相關(guān)機(jī)理。方法：健康雜種犬15只，按統(tǒng)一方法支氣管鏡下注入木瓜蛋白酶，建立非均質(zhì)型肺氣腫模型。選定右肺背側(cè)葉為手術(shù)靶區(qū)。隨機(jī)分為肺氣腫對(duì)照組（A組）、單向活瓣植入組（B組）、生物蛋白膠堵塞組（C組），每組5只。6周后，B、C組分別接受支氣管鏡下單向活瓣植入和蛋白膠堵塞。A組在相同條件下喂養(yǎng)。全部動(dòng)物于模型

2、制備前、制備后6周、手術(shù)后6周時(shí)行數(shù)據(jù)采集。包括血?dú)夥治觯≒aO2、PaCO2）、呼吸力學(xué)監(jiān)測(cè)（氣道峰壓、肺順應(yīng)性）、肺循環(huán)動(dòng)力學(xué)檢查（肺動(dòng)脈平均壓、肺毛細(xì)血管楔壓）、放射性核素肺通氣灌注掃描（放射性計(jì)數(shù)、單位面積的放射性計(jì)數(shù)）、薄層CT掃描。術(shù)后6周時(shí)處死動(dòng)物，行解剖病理學(xué)檢查。統(tǒng)計(jì)學(xué)處理數(shù)據(jù)并進(jìn)行組間比較。結(jié)果：模型建立后全部實(shí)驗(yàn)犬PaO2降低，PaCO2上升，肺動(dòng)脈壓上升，肺順應(yīng)性下降（P<0.05）。感興趣區(qū)CTS/PIX通氣灌注均下降（P<0.05）。BLVR后B組PaO2升高，PaCO2下降（P<0.05）；B、C兩組肺動(dòng)脈壓力無(wú)變化（P>0.05），肺順應(yīng)

3、性增加（P<0.05），手術(shù)區(qū)肺通氣、灌注CTS/PIX均顯著下降（P<0.01，P<0.05），且與對(duì)照組有統(tǒng)計(jì)學(xué)差異（P<0.05）。病理學(xué)證實(shí)術(shù)后靶區(qū)肺組織有肺泡萎陷、實(shí)變、間質(zhì)結(jié)締組織增生等改變。結(jié)論：?jiǎn)蝹?cè)BLVR術(shù)后肺功能較術(shù)前改善。手術(shù)靶區(qū)通氣血流均減少，通氣血流比例下降。全肺循環(huán)未受影響，血流重分布，有利于肺功能改善。關(guān)鍵詞：經(jīng)支氣管鏡肺減容術(shù) 非均質(zhì)型肺氣腫 通氣血流重分布 Effects of Ventilation/Perfusion of BLVR in an experimental Canine Model of COPDAbstractObj

4、ective: We generated an experimental canine model of heterogeneous emphysema. The dogs subsequently underwent unilateral bronchoscopic lung volume reduction (BLVR). Observing the postoperative condition of ventilation/perfusion, blood gas analysis, respiratory dynamics, hemodynamic measurement, HRCT

5、 and radiologic outcomes, compared with the preoperative level, the correlative mechanism and the effects of BLVR were analyzed.Methods: There were 15 healthy dogs that were treated samely with localized papain instillations under bronchoscopic guidance to generate heterogeneous emphysema. The right

6、 dorsal lobe was selected as the target area. All dogs were divided into 3 groups randomly. Group A was control group; Group B and Group C received BLVR 6 weeks later while group A was raised as the same way. Group B underwent endobronchial valve insertion (EVI); Group C underwent bronchial blocking

7、 with albumin gel. Measurements were made in each animal at 3 time points: prior to papain exposure (base-line), after establishment of emphysema (6 weeks later), 6 weeks after BLVR. Data included blood gas analysis(PaO2,PaCO2), respiratory dynamics (respiratory peak pressure, lung compliance), hemo

8、dynamic measurement(pulmonary artery pressure, pulmonary capillary vessel wedge pressure), nuclear ventilation/perfusion scan(CTS, CTS/PIX), quantitative CT. Dogs were euthanized at 6-week time point followed by autopsy. The data was statistically managed and compared.Results: After development of e

9、mphysema, all dogs exhibitted aggravation in PaO2, PaCO2, PAP and lung compliance (P<0.05). CTS/PIX of target areas depressed in ventilation/perfusion scan(P<0.05). There was significant improvement in PaO2 and PaCO2(P<0.05), in group B at 6 weeks after BLVR. The treatment groups showed enh

10、ancement in compliance(P<0.05) and balanced PAP(P>0.05). Through ventilation/perfusion scan, CTS/PIX of the target areas reduced(P<0.01,P<0.05) which reached statistical significance in contrast of the control group(P<0.05). Pathologic outcomes demonstrated that collapse, scar and sol

11、idification was seen in the treatment animals. Conclusions: Pulmonary function revealed improvement after unilateral BLVR. Ventilation and perfusion both fell down in target areas. Furthermore, V/Q had a trend to decrease. Gross lung circulation was barely influenced. Redistribution occurred to lung perfu