杜青,雷其洪,吴玲
DU Qing; LEI Qi hong; WU Ling (Nanjing Children's Hospital;

• 1:南京医科大学附属南京市儿童医院
• 2:南京医科大学附属南京市儿童医院
• 3:南京医科大学附属南京市儿童医院 江苏南京210008
• 4:江苏南京210008

摘要(Abstract)：

目的 :观察体外膜肺 (ECMO)早期肺泡Ⅱ型上皮细胞 (ATⅡ )及肺表面活性物质 (PS)系统超微结构改变 ,探讨ECMO过程中ATⅡ功能变化 ,不断改良ECMO技术。方法 :应用电子显微镜观察体外膜肺犬ATⅡ及PS系统超微结构。结果 :ECMO组均可见PS层丧失连续、均匀绒状结构 ,脱落入肺泡腔或聚集成块现象或散落于肺泡腔内 ;可见ATⅡ板层小体减少、空泡形成 ,核变性、崩解 ;基底膜水肿、裸露 ,甚至断裂 ,炎性细胞渗出到肺泡腔。与对照组比较有显著差异 ,提示现有的ECMO治疗 6h可引起肺泡Ⅱ型上皮细胞系统超微结构的改变。结论 :现有的ECMO技术还有待改良。
Objective: To investigate the functional alternation of alveolar type Ⅱ epithelial cells (AT Ⅱ ) during extracorporeal membrane oxygenation (ECMO)for the optimigation of the ECMO technique.Methods: Transmission electronic microscope was used to observe the early morphological changes of AT Ⅱ cells and pulmonary surfactant (PS) on the ultrastructural level in dog model which were given ECMO treatment. 6 healthy dogs were randomly divided into 2 groups. 2 dogs in group A as normal control, and 4 dogs in group B for ECMO experiment. Sodium pentobarbital as anesthetic was injected into dogs of both groups. In group A, lung specimen was harvested immediately after resection of head and fixed in 2% glutaral, while in group B, the automatic respiration was blocked with morphine and supported by ventilation through tracheal intubations. Internal jugular vein and common carotid artery intubations were connected with ECMO system respectively to maintain circulation. The parameters were as following: respiration rate 6/min, PEEP 0 196 kPa, PaO 2≥6 67 kPa, PaCO 2 3 33～6 67 kPa central venous pressure 0 785～1 18 kPa, heart rate 100～150 times/min.6 hr later lung specimen were harvested and fixed in the same way. The images were compared between 2 groups under transmission electronic microscope. Results: 1)In PS lane, the normal structure were replaced by non continuous and non uniformed structure, and dropped PS was seen coagulated or scattered in alveolar cavity. 2)In AT Ⅱ cells, the lamellar body decreased, vacuole formation and nucleus degeneration were found. 3)Basement membrane looked edema, nude and even broken, and inflammatory cell merged in alveolar. Conclusion: Since there are statistical changes in the AT Ⅱ cells' structure 6 hrs after ECMO intervention, more thing have to be done to improve this technique.

关键词(KeyWords)： 肺泡;上皮细胞;肺表面活性剂;显微镜检查,电子;通气机,机械;食肉目
pulmonary alveoli; epithelial cells; pulmonary surfactants; microscopy,electron; ventilators,mechanical; carnivora

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 杜青,雷其洪,吴玲
DU Qing; LEI Qi hong; WU Ling (Nanjing Children's Hospital;

DOI: 10.19367/j.cnki.1000-2707.2003.03.007

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