肺灌注中吸烟史供肺发生过度充气伴肺功能障碍
Hyperinflation With Pulmonary Dysfunction in Donor Lungs With Smoking History During Lung Perfusion.
机构信息
Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Transplant Center, Cleveland Clinic, Cleveland, Ohio.
出版信息
J Surg Res. 2020 Nov;255:502-509. doi: 10.1016/j.jss.2020.05.019. Epub 2020 Jul 2.
BACKGROUND
Donor lungs with smoking history are perfused in ex vivo lung perfusion (EVLP) to expand donor lung pool. However, the impact of hyperinflation of perfused lungs in EVLP remains unknown. The aim of this study was to investigate the significance of hyperinflation, using an ex vivo measurement delta V, during EVLP in smoker's lungs.
MATERIALS AND METHODS
Seventeen rejected donor lungs with smoking history of median 10 pack-years were perfused for 2 h in cellular EVLP. Hyperinflation was evaluated by measuring delta V = inspiratory - expiratory tidal volume (V) difference at 1 h. All lungs were divided into two groups; negative delta V (n = 11, no air-trapping pattern) and positive delta V (n = 6, air-trapping pattern). Transplant suitability was judged at 2 h. By using lung tissue, linear intercept analysis was performed to evaluate the degree of hyperinflation.
RESULTS
The positive delta V group had significantly lower transplant suitability than the negative delta V group (16 versus 81%, P = 0.035). The positive delta V group was significantly associated with lower partial pressure of oxygen/fraction of inspired oxygen ratio ratio (278 versus 356 mm Hg, P = 0.049), higher static compliance (119 versus 98 mL/cm HO, P = 0.050), higher lung weight ratio (1.10 versus 0.96, P = 0.014), and higher linear intercept ratio (1.52 versus 0.93, P = 0.005) than the negative delta V group.
CONCLUSIONS
Positive delta V appears as an ex vivo marker of ventilator-associated lung hyperinflation of smoker's lungs during EVLP.
背景
有吸烟史的供体肺在体外肺灌注 (EVLP) 中进行灌注以扩大供体肺库。然而，EVLP 中灌注肺过度充气的影响尚不清楚。本研究旨在探讨 EVLP 中吸烟者肺过度充气的意义，使用体外测量的 delta V。
材料和方法
17 例有吸烟史的废弃供体肺，中位吸烟史为 10 包年，在细胞 EVLP 中灌注 2 小时。通过测量 delta V=吸气-呼气潮气量 (V) 差异来评估过度充气，在 1 小时时进行测量。所有肺均分为两组；负 delta V（n=11，无空气陷闭模式）和正 delta V（n=6，空气陷闭模式）。在 2 小时时判断移植的适宜性。通过使用肺组织，进行线性截距分析以评估过度充气的程度。
结果
正 delta V 组的移植适宜性明显低于负 delta V 组（16%比 81%，P=0.035）。正 delta V 组与较低的氧分压/吸入氧分数比值（278 比 356 毫米汞柱，P=0.049）、较高的静态顺应性（119 比 98 毫升/厘米 H2O，P=0.050）、较高的肺重比（1.10 比 0.96，P=0.014）和较高的线性截距比（1.52 比 0.93，P=0.005）显著相关。
结论
正 delta V 似乎是 EVLP 期间吸烟者肺过度充气的体外标志物。
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