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目的比较单侧膈神经切断对不同年龄幼猪肺功能及肺组织形态影响的差异,为临床上确定小儿行膈神经移位术的安全年龄范围提供理论及实验依据。方法健康雄性幼猪36只,按手术时日龄(10d、30d、50d)分为3组,每组12只,实验组6只,对照组6只。实验组于颈部将左侧膈神经切断,对照组仅行左侧膈神经暴露。分别于术前、术后30min及生长至3月龄时检测动脉血气、肺功能及进行胸透,并于3月龄时观察肺组织学改变。结果单侧膈神经切断后30min,10d及30d实验组分钟通气量(MV)和吸入潮气量(VTins)较术前下降(P<0.05),50d实验组分钟通气量及吸入潮气量较术前无明显改变(P>0.05);3月龄时,各实验组与对照组比较分钟通气量和吸入潮气量均无显著差异(P>0.05),但10d及30d实验组动态顺应性(Cdyn)下降(P<0.05),气道阻力(Raw)增高(P<0.05),50d实验组动态顺应性、气道阻力与对照组比较无明显差异(P>0.05)。3月龄时实验组与对照组肺组织学比较,10d实验组左肺及右肺下半区肺泡直径(Da)减小,肺泡隔密度(Ds)增加(P<0.05),30d实验组仅左肺下半区肺泡直径减小、肺泡隔密度增加(P<0.05),而50d实验组双肺各区肺泡直径及肺泡隔密度与对照组比较均无显著差异(P>0.05)。结论单侧膈神经切断将影响术时年龄较小幼猪的肺功能及肺组织形态,手术年龄越小影响越显著,而术时年龄较大幼猪膈神经切断对呼吸系统影响不明显。
Objective To compare the effects of unilateral phrenic nerve transection on the lung function and lung morphology of young piglets of different ages and to provide theoretical and experimental evidences for clinically determining the safe age range of phrenic nerve transposition in children. Methods Thirty - six healthy male piglets were divided into 3 groups according to the days of operation (10 days, 30 days, 50 days), 12 in each group, 6 in experimental group and 6 in control group. In the experimental group, the left phrenic nerve was cut off in the neck and the left phrenic nerve was exposed in the control group. Arterial blood gas, lung function and chest X-ray were detected before operation, 30min after operation and 3 months after operation. Lung histology was observed at 3 months of age. Results After 30 minutes, 10 days and 30 days of unilateral phrenic nerve transection, the minute ventilation (MV) and the tidal volume of inspiratory air (VTins) decreased significantly compared with that before operation (P <0.05). The minute ventilation and the tidal volume of inhalation in the experimental group (P> 0.05). There were no significant differences in minute ventilation and tidal volume of inhalation at 3 months (P> 0.05) between the experimental group and the control group. However, the dynamic compliance (Cdyn) (P <0.05). The airway resistance (Raw) increased (P <0.05). The dynamic compliance and the airway resistance of the 50 d experimental group had no significant difference compared with the control group (P> 0.05). At 3 months of age, the alveolar diameter (Da) and the alveolar septum density (Ds) increased in the left and right lung of the 10-day experimental group compared with the control group The diameter of the alveoli in the lower left lung region decreased and the alveolar septum density increased (P <0.05). However, there was no significant difference in alveolar diameter and alveolar septum density between the two groups (P> 0.05). Conclusion The unilateral phrenic nerve transection will affect the lung function and lung morphology of the younger pigs. The younger the operative age, the more significant the impact is. However, the phrenic nerve cut-off of the younger pigs has no significant effect on the respiratory system.