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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) mmHg，潮气量为(404±100) mL(15 mmHg压力支持下)，静止顺应性为(29±4) mL/cmH2O，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。 Abstract: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/cmH2O 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. -
Key words:
- Lung transplantation /
- Swine /
- Donor lung procurement /
- Animal surgery /
- Lung perfusion /
- Static compliance /
- Airway pressure /
- Tidal volume /
- Oxygenation index
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图 1 猪供体取肺手术中从切皮到肺灌注的时间随操作次数增加的变化曲线
Figure 1. Change curve of time from incision to perfusion of swine donor lung procurement with the increase times of operation
图 2 猪供体肺灌注前的氧合指数随操作次数增加的变化曲线
Figure 2. Change curve of oxygenation index before swine donor lung perfusion with the increase times of operation
图 3 猪供体肺灌注前的潮气量(予15 mmHg压力支持)随操作次数增加的变化曲线
Figure 3. Change curve of tidal volume before swine donor lung perfusion (with 15 mmHg pressure support) with the increase times of operation
图 4 猪供体肺灌洗前的静止顺应性随操作次数增加的变化曲线
Figure 4. Change curve of static compliance before swine donor lung perfusion with the increase times of operation
表 1 15例猪供体肺获取手术的操作失误及频率
Table 1. Operating error frequency of donor lung procurement surgery in 15 swine models
失误类型 项目 频率 解剖操作性失误 分离上腔静脉出血 2 损伤气管 1 肺动脉插管相关失误 刀片切开肺动脉时切断荷包线 1 肺动脉导管脱出出血 3 肺动脉切口太小，无法置入导管，二次切开 2 灌洗时肺动脉导管侧孔脱出 1 步骤性失误 切开下腔静脉远心端，胸腔大量出血 1 忘记持续吸气状态后切断气管 1 灌洗前忘记切开左心耳 2 忘记注射前列腺素 1 
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