Moriyasu K, McKeown P P, Novitzky D, Snow T R
Department of Surgery, University of South Florida, Tampa, USA.
J Heart Lung Transplant. 1995 Jul-Aug;14(4):699-705.
To achieve successful lung transplantation, it is essential to minimize reperfusion injury occurring as a result of metabolite accumulation during the preservation period or at the time of initial interaction of blood with constricted pulmonary vasculature. Initial reperfusion with warm crystalloid solution may be advantageous in preventing this injury.
This study was designed to evaluate the effect of low-potassium (4 mmol/L) dextran (1%) solution as the initial warming solution after 6 hours of hypothermic storage. In 23 New Zealand White rabbits the lungs were flushed with low-potassium dextran solution (10 degrees C, 40 ml/kg, 600 cm H2O), excised, inflated with room air, and stored in a low-potassium dextran solution (10 degrees C) for 6 hours. After storage, the lungs were divided into two groups. Group 1 (n = 8) was reperfused with warm low potassium dextran for 4 minutes, at 37 degrees C followed by blood reperfusion for 30 minutes at 37 degrees C. Group II (n = 15) was reperfused only with blood for 30 minutes at 37 C. The mean pulmonary vascular resistance measured during cold flush and prior to storage was similar in both groups (group I = 20.0 +/- 5.9 mm Hg.sec/ml, group II = 19.3 +/- 1.9 mm Hg.sec/ml).
During reperfusion, only 4 of the 15 lungs in group II maintained an acceptable (< 80 mm Hg) mean pulmonary artery pressure; six failed immediately. All eight lungs in group I completed the 30-minute reperfusion (p < 0.005). The mean pulmonary artery pressure was significantly less, and effluent oxygen tension was significantly greater in group I during reperfusion.
In this experimental model, initial warm reperfusion with low-potassium dextran ameliorated the deleterious effects of reperfusion, thus providing an environment to improve lung preservation.
为实现成功的肺移植，必须尽量减少在保存期或血液与收缩的肺血管初次相互作用时因代谢物积累而发生的再灌注损伤。用温晶体溶液进行初始再灌注可能有利于预防这种损伤。
本研究旨在评估低钾（4 mmol/L）右旋糖酐（1%）溶液作为低温保存6小时后的初始复温溶液的效果。在23只新西兰白兔中，用低钾右旋糖酐溶液（10℃，40 ml/kg，600 cm H2O）冲洗肺部，切除，用室内空气充气，并在低钾右旋糖酐溶液（10℃）中保存6小时。保存后，将肺部分为两组。第一组（n = 8）在37℃用温低钾右旋糖酐再灌注4分钟，然后在37℃进行血液再灌注30分钟。第二组（n = 15）仅在37℃用血液再灌注30分钟。两组在冷冲洗期间和保存前测得的平均肺血管阻力相似（第一组 = 20.0 +/- 5.9 mmHg·sec/ml，第二组 = 19.3 +/- 1.9 mmHg·sec/ml）。
在再灌注期间，第二组15只肺中只有4只维持了可接受的（< 80 mmHg）平均肺动脉压；6只立即失败。第一组的所有8只肺都完成了30分钟的再灌注（p < 0.005）。再灌注期间，第一组的平均肺动脉压显著更低，流出液氧张力显著更高。
在本实验模型中，用低钾右旋糖酐进行初始温再灌注改善了再灌注的有害影响，从而为改善肺保存提供了一个环境。
