摘要
目的探讨猪供肺获取手术的技术训练方法与评估指标。方法总结15只猪供肺获取手术的手术技巧,评估手术时间、灌注前的客观评价指标、灌注后的大体观、术中操作失误及频率等。结果 15只猪供肺获取手术均顺利完成。从切皮到肺灌洗开始平均时间为22.6 min。灌注前供肺的氧合指数为(501±68)mm Hg,潮气量为(404±100)mL(15 mm Hg压力支持下),静止顺应性为(29±4)mL/cm H_2O,随着操作次数增加,氧合指数和潮气量有所改善。供肺灌注后大部分肺膨胀良好。手术出现多种操作失误,包括解剖操作性失误、肺动脉插管相关失误、步骤性失误等,随着操作次数增加,失误频率明显减少。结论经过一定量的猪肺获取手术的训练,术中步骤性失误明显减少,肺质量也会有改善趋势。氧合指数等客观指标和供肺大体观可评估手术技术水平。
Objective To investigate the training methods and evaluation parameters for donor lung procurement technique in swine models. Methods The surgical skills of donor lung procurement in 15 swine models were summarized. The operation time, objective evaluation parameters before lung perfusion, gross observation after lung perfusion, the type and frequency of intraoperative errors were assessed. Results All donor lung procurement surgeries were successfully completed in 15 swine models. The mean time interval from skin incision to lung perfusion was 22.6 min. Prior to lung perfusion, the oxygenation index of the donor lung was （501 ± 68） mmHg, （404±100） mL （under the pressure of 15 mmHg） for the tidal volume and （29±4） mL/cmH20 for the static compliance. Along with the increasing surgical frequency, the oxygenation index and tidal volume were improved. Favorable lung inflation was obtained after lung perfusion in a majority of swine models. Intraoperatively, multiple operating errors occurred including dissection error, pulmonary arterial intubation error and procedure error, etc. As the frequency of operation increased, the frequency of surgical errors was significantly decreased. Conclusions After certain training for donor lung procurement in swine models, the incidence of intraoperative procedure error is significantly reduced and the quality of the donor lung tends to be enhanced. Objective parameters, such as oxygenation index and the gross shape of the donor lung can be utilized to evaluate the levels of surgical techniques.
出处
《器官移植》
CAS
CSCD
2017年第5期344-348,共5页
Organ Transplantation
基金
国家留学基金委青年骨干教师出国研修项目(201406285105)
关键词
肺移植
猪
供肺获取
动物手术
肺灌洗
静止顺应性
气道压力
潮气量
氧合指数
Lung transplantation
Swine
Donor lung procurement
Animal surgery
Lung perfusion
Staticcompliance
Airway pressure
Tidal volume
Oxygenation index
作者简介
王哲，Email：wangzheradish@sohu.com.
Liu Mingyao，Email：mingyao．1iu@utoronto．ca
