Silva César Augusto Melo, Carvalho Rodrigo Storck, Cagido Viviane Ramos, Zin Walter Araújo, Tavares Paulo, DeCampos Kleber Nogueira
Laboratory of Respiratory Physiology, University of Brasília, Brasília, DF, Brazil.
Interact Cardiovasc Thorac Surg. 2010 Jul;11(1):46-51. doi: 10.1510/icvts.2009.222018. Epub 2010 Apr 8.
We tested the hypothesis that lung preservation techniques disarrange lung architecture, increase pulmonary impedance and lead to ischemia-reperfusion injury, which can be prevented by re-establishment of optimal lung geometry. In the first phase, fresh, cold ischemic, preserved lungs insufflated to total lung capacity (TLC) and preserved lungs ventilated with tidal volume prior to reperfusion were submitted to a 60-min ex-vivo reperfusion to evaluate the gas exchange, pulmonary hemodynamic and lung mechanics' properties. In the second phase, we evaluated the mechanical properties of lungs submitted to the same conditions of the first phase. Cold ischemic lungs developed fulminant edema during the first 15 min of ex-vivo reperfusion, whereas gas exchange, hemodynamic and mechanic properties of lungs insufflated to TLC and ventilated during 10 min prior to reperfusion were similar to fresh lungs. After the pulmonary vascular flush pulmonary impedance and alveolar collapsed area increased significantly. The insufflation to TLC and 10 min of tidal ventilation reduced the lung impedance and the percentage of alveolar collapsed area. Lung preservation techniques disarrange alveolar architecture, which lead to ischemia-reperfusion injury; recruitment maneuvers decrease the pulmonary inhomogeneities and protect the lungs against the ischemia-reperfusion injury.
肺保存技术会扰乱肺结构，增加肺阻抗并导致缺血再灌注损伤，而通过重建最佳肺几何结构可预防这种损伤。在第一阶段，将新鲜肺、冷缺血肺、灌注至肺总量（TLC）的保存肺以及再灌注前用潮气量通气的保存肺进行60分钟的体外再灌注，以评估气体交换、肺血流动力学和肺力学特性。在第二阶段，我们评估了处于与第一阶段相同条件下的肺的力学特性。冷缺血肺在体外再灌注的前15分钟内出现暴发性水肿，而灌注至TLC并在再灌注前通气10分钟的肺的气体交换、血流动力学和力学特性与新鲜肺相似。肺血管冲洗后，肺阻抗和肺泡塌陷面积显著增加。灌注至TLC并进行10分钟的潮气量通气可降低肺阻抗和肺泡塌陷面积百分比。肺保存技术会扰乱肺泡结构，导致缺血再灌注损伤；复张手法可减少肺内不均一性并保护肺免受缺血再灌注损伤。
