| Chronic obstructive pulmonary disease is short for COPD, is a devastating lung diseases, which cause serious damage to the human body health is not completely reversible airflow limited as the main characteristics of the disease, the airflow limitation is generally a progressive developent,at the same time, with the exception of the lung to noxious particles or gases and related inflammatory reaction. With the development of the society, COPD has become a public health problem of the whole society can not be ignored, is due to chronic obstructive pulmonary disease cannot be cured for a long time, and to assume the progressive development, leading to more complication, bringing a great impact on the life and work of the patients, but also bring huge economic burden to the patient’s family. COPD is a chronic airway inflammatory disease which can be prevention and treatment, and the mortality rate is higher, at the same time will bring heavy economic burden to the family and society, and affect the quality of life of patients. Emphysema in pathology mainly for lung terminal bronchioles chamber on the far side of the longer time is not normal expansion, but also accompanied by bronchioles and alveolar walls without obvious fibrosis, and its destruction phenomena appear.Although COPD only involving the airway disease,but its impact on patient’s body system cannot be ignored.In recent years, lung volume reduction surgery(LVRS) is an effective method for the treatment of emphysema and are widely used in medical surgery field, according to the patients’ lung function and blood gas analysis situation, the location of the lesions and the condition of nature, can make lung partial resection or side of all lung resection, or on both sides of lobe resection. In theory, clinic patients with pulmonary resection range should be able to make the pulmonary lesions were resected completely, cannot leave the lesion, to prevent disease recurrence; but at the same time also can not cut too much lung tissue, the doctor should be reserved for patients with normal lung tissue more, as is the maintenance of pulmonary function of the patients have a higher quality of life right. Many clinical studies showed that lung volume reduction surgery can improve the symptom of dyspnea in patients, so that patients can recover. But most of previous studies are clinical observation for the lung, cardiovascular function or chest wall and other parts of the case, there is no effective lung volume reduction operation of clinical and objective basis for the application.From the current point of view, according to the mechanism of the pathogenesis of chronic obstructive pulmonary disease, on the basis of COPD treatment in the department of internal medicine, poor treatment effect, surgical operation instrument technology continues to improve and the patient’s own on the treatment effect of the disease gradually increased, how to make unilateral, bilateral lung volume reduction surgery in patients with chronic obstructive pulmonary disease in the use of more widely, and better effect of reducing lung volume consolidation, which is a new topic in nowadays, medical workers and researchers need to work together to deal with and research hotspot.Aims Chronic obstructive pulmonary disease (COPD) is characterized by an airflow limitation that is not fully reversible characteristics, a chronic disease development, the patients with lung function was damaged, and cause breathing difficulties and endurance fell in the patient’s own activities.FEV1% can reflect the severity of COPD disease, but not fully reflect the quality of life in patients with COPD. This study is the rabbit emphysema animal model by constructing a smoke inhalation and intratracheal instillation of papain, based on the research of the pathogenesis of existing emphysema, the purpose is to explore plateau area(Refers to the general altitude of over 1000 meters, the surrounding area is vast, open terrain, bounded by steep slope, large scale uplift area complete called plateau.) of unilateral and bilateral lung volume reduction surgery for emphysema whether there are any changes in rabbit arterial blood gas analysis before and after operation, observing the proliferation and apoptosis of lung volume reduction surgery whether is changed before and after operation,from the morphology and function of pathological science aspects of observation and evaluation of the animal model of unilateral and bilateral, meet the needs of reducing lung volume in the research and application of the basis of surgical emphysema, to find a more suitable method for evaluating the quality of life in patients with COPD for clinical, and evaluate the condition of patients with COPD severity.Methods The rabbits were randomly divided into normal control group (group A), emphysema group (group B), unilateral sham operation group (group C), unilateral lung volume reduction surgery group (group D), bilateral sham operation group (group E) and bilateral lung volume reduction surgery group (group F). Group 8 rabbits,48 rabbits, except A group, other five groups were used combined with smoke inhalation and intratracheal instillation of papain to establish model of emphysema. Every morning and evening for 2 times, each time 30min, for 70 consecutive days,and need to go through pathologic examination to determine whether these models conform to the application of unilateral and bilateral lung volume reduction surgery animal models of emphysema.Then the rabbit models of emphysema model of unilateral, bilateral lung volume reduction surgery (LVRS), the arterial blood gas analysis, lung histopathology analysis, to investigate the lung volume reduction surgery (LVRS) in patients with chronic obstructive pulmonary disease treatment, careful observation of lung volume reduction surgery (LVRS) changes emphysema in rabbit models of pulmonary function and alveolar morphology. Then the effect of unilateral, bilateral LVRS were compared, and the detection of lung cell proliferation and apoptosis. Using SPSS 10.0 for data processing, data with x±s, comparison between groups using t test, the difference was statistically significant P<0.05.Results Compared with the control group, emphysema group, unilateral and bilateral sham operation group,unilateral and bilateral lung volume reduction surgery group of pH and PaO2 were significantly decreased, significant difference, with statistical significance (P<0.01), PaCO2 were significantly increased (P<0.01); Compared with B group, pH, PaO2, PaCO2 of C group and E group, the difference is not big, no statistical significance (P>0.05); Compared with B group, pH and PaO2 of D group and F group increased significantly, with statistical significance (P<0.05), PaCO2 was significantly decreased, the difference was statistically significant (P<0.05). D group and F group compared,F group pH and PaO2 were increased, with statistical significance (P<0.05), PaCO2 decreased, the difference was statistically significant (P<0.05).Conclusions (1)The unilateral and bilateral lung volume reduction surgery can effectively improve arterial blood gas of pulmonary emphysema rabbits.(2)With unilateral lung volume reduction surgery, bilateral lung volume reduction surgery in the improvement of arterial blood gas in emphysema rabbit were superior to other unilateral lung volume reduction surgery, but the bilateral lung volume reduction surgery is the need for bilateral thoracic operation, more prone to pulmonary air leakage in operation after a period of time, thus causing a pneumothorax. At the same time, reduce the mortality and complications of bilateral lung volume operation, such as lung or pleural infection, far higher than the unilateral lung volume reduction surgery. And bilateral lung volume reduction surgery compared with less complications, and postoperative recovery quickly.(3) Both unilateral and bilateral lung volume reduction surgery, blood gas analysis of pulmonary emphysema rabbits and pulmonary tissue structure can be recovered to the normal level.(4) Lung volume reduction surgery does not completely eliminate the symptoms of emphysema, such as the destruction of alveolar structure, tube structure changes. |
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