REINNERVATION OF REIMPLANTED CANINE LUNG
REINNERVATION OF REIMPLANTED CANINE LUNG
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DOI：
10.1152/jappl.1971.31.5.722
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发表时间：
1971-01-01
影响因子：
3.3
通讯作者：
NADEL, JA
中科院分区：
文献类型：
--
作者：
EDMUNDS, LH;GRAF, PD;NADEL, JA
方法17只成年犬（体重14-27 kg），在戊巴比妥（30 mg/kg iv）麻醉下，切除一侧肺（左16只，右1只），并将其再植。手术期间，给予硫酸阿托品（0.4 mg iv）、青霉素（300，000单位im）、链霉素（0.5 gm im）和0.9%生理盐水（500 ml iv）。术后每天重复使用抗生素5天。用肝素（100 mg在100 ml 0.9%盐水中，室温）灌注切除的肺的肺动脉。支气管动脉和肺神经在离肺段支气管起点近侧1 ~ 2cm处与肺上叶分离。先行支气管吻合，再行空气或氧气通气，同时完成心房和肺动脉闭合。没有尝试缝合切断的神经。所有缝合均采用连续4-O或5-O聚酯缝线。肺缺血40-70 min（平均56 min）。我们用戊巴比妥（30 mg/kg iv）麻醉13只狗，用气管内导管插管，并将其置于仰卧位。将股动脉导管连接至压力传感器（斯坦森Db 23），以在医用电子记录仪上连续监测血压和脉率。我们研究了吸入钽粉后X线片上的气道直径（21）。在呼气末获得所有X线片。在每张X线片中，使用带刻度的手动透镜在根据解剖标志确定的等同部位测量每个肺中的10个或更多支气管。对同一研究的每只狗的成对X线照片进行了比较，以测量气道直径的变化。我们研究了11只狗（狗1-U）的支气管收缩神经的再生。暴露同侧颈迷走神经，置于双极银电极上，并用来自Grass型S4 DR刺激器的方波脉冲（15 v; 15周期/组; 3 msec）刺激10组。在其中5只犬（犬1、3-6）中，使用静脉注射琥珀酰胆碱进行麻痹，并使用哈佛呼吸器进行通气，我们还研究了1.5-2分钟呼吸暂停引起的反射性支气管收缩（19）。在两只狗（狗5，12），我们分离和刺激两个颈部迷走神经电在不同的频率（5-30个周期/组）和恒定的强度（5 V）和持续时间（3毫秒）。我们还通过在开始同时刺激两条迷走神经（20伏; 30个周期/组; 3毫秒）后以6- 10组间隔获得X线片来研究这些狗的两个肺的支气管收缩的发生率。我们通过冷却四只狗（狗1、6、9、10）阻断同侧迷走神经的传导，以防止受刺激神经中的传入冲动到达中枢神经系统，并刺激该迷走神经（15 v; 15个周期/组; 3 msec），距冷却热电极2-5 cm。我们研究了6只狗（狗I，4-7，10）的迷走神经从对侧（右）肺的再植入（左）肺的可能再神经支配。我们通过呼吸暂停（5只狗）或迷走神经刺激（1只狗）在右肺中产生支气管收缩，同时通过冷却热电极阻断左颈迷走神经的传导。
METHODSOne lung (16 left and 1 right) was excised and reimplanted in each of 17 adult dogs (weight, 14-27 kg), during anesthesia with pentobarbital(30 mg/kg iv). During the procedure, atropine sulfate (0.4 mg iv), penicillin(300,000 units im), streptomycin(0.5 gm im), and 0.9% saline (500 ml iv) were administered. The antibiotics were repeated daily for 5 days after operation. The pulmonary artery of the excised lung was perfused with heparin (100 mg in 100 ml 0.9% saline at room temperature). The bronchial arteries and pulmonary nerves were divided l-2 cm proximal to the origin of the segmental bronchus to the upper lobe. The bronchial anastomosis was performed first and the reimplanted lung was ventilated with air or oxygen while the atria1 and pulmonary arterial anastomoses were completed. No attempt was made to approximate severed nerves. All anastomoses were made with running 4-O or 5-O polyester sutures. The lungs were ischemic for 40-70 min (mean, 56 min). We anesthetized 13 dogs with pentobarbital(30 mg/kg iv), intubated them with an endotracheal tube, and placed them in the supine position. A femoral arterial catheter was connected to a pressure transducer(Statham Db23), to monitor blood pressure and pulse rate continuously on an Electronics for Medicine recorder. We studied airway diameters on roentgenograms after insufflation of powdered tantalum(21). All roentgenograms were obtained at end expiration. In each roentgenogram, 10 or more bronchi in each lung were measured with a graduated hand lens at equivalent sites that were determined from anatomic landmarks. Pairs of roentgenograms from the same study of each dog were compared for changes in the diameters of measured airways.We studied regeneration of bronchoconstrictor nerves in 11 dogs (dogs 1-U). The ipsilateral cervical vagus nerve was exposed, placed on a bipolar silver electrode and stimulated for 10 set with square-wave pulses (15 v; 15 cycles/set; 3 msec) from a Grass model S4DR stimulator. In five of these dogs (dogs 1, 3-6) that were paralyzed with intravenous succinylcholine and ventilated with a Harvard respirator, we also studied reflex bronchoconstriction produced by 1.5-2 min of apnea (19). In two dogs (dogs 5, 12), we isolated and stimulated both cervical vagus nerves electrically at different frequencies(5-30 cycles/set) and constant intensity (5 v) and duration (3 msec). We also studied the rate of onset of bronchoconstriction of both lungs of these dogs by obtaining roentgenograms at 6-to 1 0-set intervals after beginning simultaneous stimulation of both vagus nerves (20 v; 30 cycles/set; 3 msec). We blocked conduction in the ipsilateral vagus nerve by cooling in four dogs (dogs I, 6, 9, 10) to prevent afferent impulses in the stimulated nerve from reaching the central nervous system and stimulated this vagus nerve (15 v; 15 cycles/set; 3 msec) 2-5 cm caudad to the cooling thermode. We studied possible reinnervation of the reimplanted(left) lung from the vagus nerve from the opposite (right) lung in six dogs (dogs I, 4-7, 10). We produced bronchoconstriction in the right lung by apnea (5 dogs) or vagal stimulation(1 dog) while conduction in the left cervical vagus nerve was blocked by a cooling thermode.