Legal Y M, Barthelemy R, Puel P
Department of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada.
Ann Chir. 1991;45(2):141-5.
Over the past decade, combined, heart-lung transplantation has been established as a therapeutic modality for many patients with end stage cardiopulmonary disease. However, the scarcity of suitable donors and the lack of a reliable and simple technique for distant organ procurement have somewhat limited its practice. The normothermic autoperfusion preparation has been utilized in a few satisfactory distant heart-lung preservation and subsequent transplantation, but this method is rather cumbersome. Single cold flush perfusion of the pulmonary artery with infusion of prostaglandin E1, a powerful vasodilator of the pulmonary bed, has been used successfully in heart-lung preservation for transplantation. Donor core-cooling through cardiopulmonary bypass without pulmonary artery flush perfusion appears to provide longer and better graft protection since it improves its function. The production of oxygen radicals after reperfusion of ischemic tissues has important implications in organ preservation and transplantation. Recent studies in the prevention of reperfusion injury indicate that enzymatic scavenger and iron chelator therapy may play an important role in the reduction of reperfusion injury in the clinical setting of heart-lung transplantation.
在过去十年中，心肺联合移植已成为许多终末期心肺疾病患者的一种治疗方式。然而，合适供体的稀缺以及缺乏可靠且简单的远距离器官获取技术，在一定程度上限制了其应用。常温自体灌注准备已用于少数成功的远距离心肺保存及后续移植，但该方法相当繁琐。用强力肺床血管扩张剂前列腺素E1灌注肺动脉进行单次冷冲洗灌注，已成功用于心肺移植的保存。通过体外循环进行供体核心降温而不进行肺动脉冲洗灌注，似乎能提供更长时间且更好的移植物保护，因为它能改善移植物功能。缺血组织再灌注后氧自由基的产生对器官保存和移植具有重要意义。近期关于预防再灌注损伤的研究表明，酶清除剂和铁螯合剂疗法可能在心肺移植临床环境中减少再灌注损伤方面发挥重要作用。
