Apostolakis Efstratios E, Koletsis Efstratios N, Baikoussis Nikolaos G, Siminelakis Stavros N, Papadopoulos Georgios S
Department of Cardiothoracic Surgery, University of Patras, School of Medicine, Patras, Greece.
J Cardiothorac Surg. 2010 Jan 11;5:1. doi: 10.1186/1749-8090-5-1.
During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB), hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.
在心脏直视手术期间,一系列因素的影响,如体外循环(CPB)、低温、手术和麻醉,以及药物治疗和输血,都可能导致肺部弥漫性损伤。这种损伤主要导致术后间质性肺水肿和气体交换异常。上述所有因素的实质性改善可能会使术后肺功能更好。据报道,通过避免体外循环、缩短其时间,或通过使用小型化体外循环回路减少体外表面积,对肺功能有有益影响。此外,用肝素涂层等生物相容性表面替代回路表面,以及不依赖材料的血液激活源,可观察到更好的术后肺功能。在缺血和再灌注期间使用低温和心脏停搏方法进行精心的心肌保护仍然是术后肺功能的基石之一。体外循环期间肺动脉灌注的部分恢复可能有助于预防肺缺血和肺功能障碍。使用如皮质类固醇和抑肽酶等药物,它们在体外循环期间保护肺部,以及在体外循环时间预计超过90分钟的手术中使用白细胞滤除器,似乎对体外循环对肺部的毒性影响有保护作用。用于清除促炎因子的新型超滤方法似乎对肺功能有保护作用。同样,减少心内吸引装置的使用以及游离血液与心包的接触时间,预计术后肺功能会得到改善。