Schneuwly O D, Licker M, Pastor C M, Schweizer A, Slosman D O, Kapanci Y, Nicod L P, Robert J, Spiliopoulos A, Morel D R
Divisions of Anesthesiological Investigations, Nuclear Medicine, Clinical Pathology, and Pneumology, Unit of Thoracic Surgery, University Hospital of Geneva, Geneva, Switzerland.
Am J Respir Crit Care Med. 1999 Aug;160(2):689-97. doi: 10.1164/ajrccm.160.2.9809029.
Modified Euro-Collins (EC) solution, a crystalloid intracellular-type solution, has been commonly used for pulmonary preservation. Several experimental studies have shown the advantages of using extracellular colloid-based solutions. The aim of this study was to compare the quality of preservation of two extracellular colloid solutions, leukocyte-depleted blood (BL) and low-potassium dextran (LPD) solutions, with that of EC solution. Lungs of 22 domestic pigs were flushed and preserved with EC (n = 8), BL (n = 7), or LPD (n = 7) solution. After harvesting, one of the lungs was reperfused immediately in an ex vivo circuit (control lungs), whereas the contralateral lung was reperfused after 8 h of cold (4 degrees C) storage (preserved lungs). Besides the lung function parameters (gas exchange, pulmonary hemodynamics and mechanics), the permeability of the endothelial-epithelial barrier was assessed by determining the transferrin leak index (TLI) using a double radioisotopic method, by measuring the alveolar/arterial protein concentration ratio, and by analyzing histopathologic changes. The functional quality (oxygenation, airway resistance, dynamic compliance [CL, dyn]) of both BL and LPD lungs was slightly but significantly superior to that of EC lungs. However, pulmonary vascular resistance was lower in BL-preserved than in EC- or LPD-preserved lungs. The TLI was increased in EC control and preserved lungs, whereas it was low in BL and LPD control lungs and did not increase after preservation. The alveolar/arterial protein concentration ratio was not different between control groups, but was increased fourfold in EC-preserved compared with BL- or LPD-preserved lungs. Finally, EC-preserved lungs presented a weight gain about twice that of BL- and LPD-preserved lungs. Morphologic analysis confirmed these results, because in the EC-preserved lungs, rupture of alveolar septa and severe alveolar edema and hemorrhage were observed, whereas BL- and LPD-preserved lungs showed a relatively well-preserved structure. The results demonstrate that both BL and LPD flush solutions preserve the endothelial-epithelial barrier better than does EC solution. Although the quality of preservation is similar, pulmonary vascular resistance is higher in LPD-preserved than in BL-preserved lungs.
改良的欧-柯林（EC）溶液是一种晶体细胞内型溶液，常用于肺保存。多项实验研究显示了使用细胞外胶体溶液的优势。本研究的目的是比较两种细胞外胶体溶液，即去白细胞血液（BL）和低钾右旋糖酐（LPD）溶液，与EC溶液的保存质量。22头家猪的肺用EC溶液（n = 8）、BL溶液（n = 7）或LPD溶液（n = 7）进行冲洗和保存。收获后，其中一侧肺立即在体外循环中进行再灌注（对照肺），而对侧肺在4℃冷保存8小时后进行再灌注（保存肺）。除了肺功能参数（气体交换、肺血流动力学和力学）外，还通过双放射性同位素法测定转铁蛋白渗漏指数（TLI）、测量肺泡/动脉蛋白浓度比以及分析组织病理学变化来评估内皮-上皮屏障的通透性。BL和LPD保存肺的功能质量（氧合、气道阻力、动态顺应性[CL，dyn]）略优于但显著优于EC保存肺。然而，BL保存肺的肺血管阻力低于EC或LPD保存肺。TLI在EC对照肺和保存肺中升高，而在BL和LPD对照肺中较低，且保存后未升高。对照组之间的肺泡/动脉蛋白浓度比无差异，但与BL或LPD保存肺相比，EC保存肺中该比值增加了四倍。最后，EC保存肺的重量增加约为BL和LPD保存肺的两倍。形态学分析证实了这些结果，因为在EC保存肺中观察到肺泡间隔破裂、严重肺泡水肿和出血，而BL和LPD保存肺显示结构相对保存良好。结果表明，BL和LPD冲洗溶液比EC溶液能更好地保存内皮-上皮屏障。尽管保存质量相似，但LPD保存肺的肺血管阻力高于BL保存肺。
