Song Yi, Gong Xing-jun, Gu Xing-hua, Li Ran, Zhang Gong, Zhang Xi-quan
Department of Cardiac Surgery, Qilu Hospital of Shandong University, Jinan 250012, China.
Zhonghua Yi Xue Za Zhi. 2006 May 30;86(20):1421-4.
To observe the influence of intra-operative pulmonary artery perfusion with hypothermic washed red blood cell (RBC) solution on lung injury after cardiopulmonary bypass (CPB).
Thirty patients of mitral disease with pulmonary hypertension undergoing mitral valve replacement were randomly divided into 2 equal groups: control group, and perfusion group (with the pulmonary artery infused with 4 degrees C washed RBC protective solution during CPB). The blood cell count, pulmonary vascular resistance (PVR), white blood cell (WBC) ratio (venous blood/arterial blood), plasma malonyldialdehyde (MDA), and oxygenation index (OI), were measured and the time of mechanical ventilation was obtained as well.
(1) The PVR at the end of CPB, and 12 h and 24 h after CPB of the perfusion group were 46.4 kPa.s.L(-1) +/- 8.1 kPa.s.L(-1), 48.5 kPa.s.L(-1) +/- 7.0 kPa.s.L(-1), and 36.1 kPa.s.L(-1) +/- 6.3 kPa.s.L(-1) respectively, all significantly lower than those of the control group (65.7 kPa.s.L(-1) +/- 5.3 kPa.s.L(-1), 79.8 kPa.s.L(-1) +/- 8.7 kPa.s.L(-1), and 47.9 kPa.s.L(-1) +/- 7.1 kPa.s.L(-1) respectively, all P < 0.05). (2) The levels of MDA at the end of CPB, and 12 h and 24 h after CPB of the perfusion group were 14.3 mmol/L +/- 0.8 mmol/L, 16.1 mmol/L +/- 0.7 mmol/L, and 13.3 mmol/L +/- 0.5 mmol/L respectively, all significantly lower than those of the control group (18.9 mmol/L +/- 0.9 mmol/L, 21.6 mmol/L +/- 0.4 mmol/L, and 22.5 mmol/L +/- 0.7 mmol/L respectively, all P < 0.05). (3) The WBC ratios of vein and artery (V/A) a the end of CPB and 12 h after CPB of the perfusion group were 1.16 +/- 0.05 and 1.20 +/- 0.05 respectively, both significantly lower than those of the control group (1.53 +/- 0.07 and 1.68 +/- 0.25 respectively (both P < 0.01). (4) The OI at the end of CPB, and 12 h and 24 h after CPB of the perfusion group were 370 +/- 33, 388 +/- 41, and 414 +/- 39 respectively, all significantly higher than those of the control group (217 +/- 30, 210 +/- 36, and 222 +/- 33 respectively (all P < 0.05). (5) The time of mechanical ventilation the perfusion group was 13 h +/- 4 h, significantly shorter than that of the control group (27 h +/- 6 h, P < 0.01).
Pulmonary artery perfusion with hypothermic washed RBC protective solution alleviates the lung injury after cardiopulmonary bypass.
观察术中肺动脉灌注低温洗涤红细胞（RBC）溶液对体外循环（CPB）后肺损伤的影响。
将30例二尖瓣病变合并肺动脉高压行二尖瓣置换术的患者随机分为两组，每组15例：对照组和灌注组（CPB期间肺动脉输注4℃洗涤RBC保护液）。检测血细胞计数、肺血管阻力（PVR）、白细胞（WBC）比值（静脉血/动脉血）、血浆丙二醛（MDA）和氧合指数（OI），并记录机械通气时间。
（1）灌注组CPB结束时、CPB后12 h及24 h的PVR分别为46.4 kPa·s·L⁻¹±8.1 kPa·s·L⁻¹、48.5 kPa·s·L⁻¹±7.0 kPa·s·L⁻¹和36.1 kPa·s·L⁻¹±6.3 kPa·s·L⁻¹，均显著低于对照组（分别为65.7 kPa·s·L⁻¹±5.3 kPa·s·L⁻¹、79.8 kPa·s·L⁻¹±8.7 kPa·s·L⁻¹和47.9 kPa·s·L⁻¹±7.1 kPa·s·L⁻¹，均P<0.05）。（2）灌注组CPB结束时、CPB后12 h及24 h的MDA水平分别为14.3 mmol/L±0.8 mmol/L、16.1 mmol/L±0.7 mmol/L和13.3 mmol/L±0.5 mmol/L，均显著低于对照组（分别为18.9 mmol/L±0.9 mmol/L、21.6 mmol/L±0.4 mmol/L和22.5 mmol/L±0.7 mmol/L，均P<0.05）。（3）灌注组CPB结束时及CPB后12 h的静脉与动脉白细胞比值（V/A）分别为1.16±0.05和1.20±0.05，均显著低于对照组（分别为1.53±0.07和1.68±0.25，均P<0.01）。（4）灌注组CPB结束时、CPB后12 h及24 h的OI分别为370±33、388±41和414±39，均显著高于对照组（分别为217±30、210±36和222±33，均P<0.05）。（5）灌注组机械通气时间为13 h±4 h，显著短于对照组（27 h±6 h，P<0.01）。
肺动脉灌注低温洗涤RBC保护液可减轻体外循环后的肺损伤。
