Toledo-Pereyra L H, Hau T, Simmons R L, Najarian J S
Ann Thorac Surg. 1977 May;23(5):487-94. doi: 10.1016/s0003-4975(10)64176-8.
Some of the barriers to successful lung transplantation include the lack of acceptable methods for ischemic protection and the absence of reliable systems for preservation. The lung response to 60 minutes of warm ischemia basically consists of alveolar-capillary edema and disruption, mitochondria swelling, interstitial hemorrhage, significantly depressed pulmonary function, elevation of pulmonary vascular resistance, and considerable drop in levels of glucose, phospholipids, and adenosine triphosphate. The tolerance to warm ischemia increases to several hours with the use of different systems of ventilatory assistance with or without positive end-expiratory pressure. Several methods of preservation have been attempted: hypothermia, hyperbaria, and hypothermic pulsatile or nonpulsatile perfusion. Hypothermic pulsatile perfusion appears to offer longer periods of protection than the other methods. Longer periods of ischemia and extended preservation may be made possible by advances in the use of drug protection during warm ischemia and the utilization of intracellular colloid or noncolloid solutions for hypothermic storage or hypothermic pulsatile perfusion.
成功进行肺移植的一些障碍包括缺乏可接受的缺血保护方法以及可靠的保存系统。肺对60分钟热缺血的反应主要包括肺泡 - 毛细血管水肿和破坏、线粒体肿胀、间质出血、肺功能显著降低、肺血管阻力升高以及葡萄糖、磷脂和三磷酸腺苷水平大幅下降。通过使用不同的通气辅助系统（有无呼气末正压），对热缺血的耐受性可增加至数小时。已经尝试了几种保存方法：低温、高压以及低温搏动或非搏动灌注。低温搏动灌注似乎比其他方法能提供更长时间的保护。通过在热缺血期间使用药物保护以及利用细胞内胶体或非胶体溶液进行低温储存或低温搏动灌注方面的进展，可能实现更长时间的缺血和延长保存。
