Department of Cardiac Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
J Thorac Cardiovasc Surg. 2010 Jan;139(1):174-80. doi: 10.1016/j.jtcvs.2009.08.036. Epub 2009 Nov 17.
Pulmonary ischemia and reperfusion during routine open heart surgery with cardiopulmonary bypass can lead to pulmonary dysfunction and vasoconstriction, resulting in a high morbidity and mortality. We investigated whether ischemia/reperfusion-induced pulmonary dysfunction after full-flow cardiopulmonary bypass could be prevented by the infusion of leukocyte-depleted hypoxemic blood during the early phase of reperfusion (terminal leukocyte-depleted lung reperfusion) and whether the benefits of this method were nullified by using hyperoxemic blood for reperfusion.
Twenty-one neonatal piglets underwent 180 minutes of full-flow cardiopulmonary bypass with pulmonary artery occlusion, followed by reperfusion. The piglets were divided into 3 groups of 7 animals. In group I, uncontrolled reperfusion was achieved by unclamping the pulmonary artery. In contrast, pulmonary reperfusion was done with leukocyte-depleted hyperoxemic blood in group II or with leukocyte-depleted hypoxemic blood in group III for 15 minutes at a flow rate of 10 mL/min/kg before pulmonary artery unclamping. Then the animals were monitored for 120 minutes to evaluate post-cardiopulmonary bypass pulmonary function.
Group I developed pulmonary dysfunction that was characterized by an increased alveolar-arterial oxygen difference (204 + or - 57.7 mm Hg), pulmonary vasoconstriction, and decreased static lung compliance. Terminal leukocyte-depleted lung reperfusion attenuated post-cardiopulmonary bypass pulmonary dysfunction and vasoconstriction when hypoxemic blood was used for reperfusion (alveolar-arterial oxygen difference, 162 + or - 61.0 mm Hg). In contrast, no benefit of terminal leukocyte-depleted lung reperfusion was detected after reperfusion with hyperoxemic blood (alveolar-arterial oxygen difference, 207 + or - 60.8 mm Hg).
Reperfusion with leukocyte-depleted hypoxemic blood has a protective effect against ischemia/reperfusion-induced pulmonary dysfunction by reducing endothelial damage, cytokine release, and leukocyte activation.
体外循环常规心脏手术期间的肺缺血再灌注可导致肺功能障碍和血管收缩，从而导致高发病率和死亡率。我们研究了在再灌注早期（终末白细胞耗竭性肺再灌注）输注去白细胞低氧血症血液是否可以预防全流量体外循环后缺血/再灌注引起的肺功能障碍，以及使用高氧血症血液进行再灌注是否会使这种方法的益处无效。
21 头新生仔猪接受 180 分钟的全流量体外循环，伴有肺动脉闭塞，随后再灌注。将仔猪分为 3 组，每组 7 只。在第 I 组中，通过松开肺动脉来实现不受控制的再灌注。相反，在第 II 组中，用去白细胞高氧血症血液，在第 III 组中，用去白细胞低氧血症血液，以 10 mL/min/kg 的流速进行 15 分钟的肺再灌注，然后松开肺动脉。然后监测动物 120 分钟以评估体外循环后肺功能。
第 I 组出现了肺功能障碍，其特征是肺泡-动脉氧差增加（204 ± 57.7 mm Hg）、肺血管收缩和静态肺顺应性降低。终末白细胞耗竭性肺再灌注在使用低氧血症血液进行再灌注时减轻了体外循环后的肺功能障碍和血管收缩（肺泡-动脉氧差为 162 ± 61.0 mm Hg）。相反，在用高氧血症血液进行再灌注后，终末白细胞耗竭性肺再灌注没有益处（肺泡-动脉氧差为 207 ± 60.8 mm Hg）。
用去白细胞低氧血症血液再灌注可通过减少内皮损伤、细胞因子释放和白细胞激活来减轻缺血/再灌注引起的肺功能障碍，从而具有保护作用。
