Puskas J D, Oka T, Mayer E, Wisser W, Downey G P, Slutsky A S, Patterson G A
Division of Thoracic Surgery, Toronto Hospital, Ontario, Canada.
Ann Thorac Surg. 1994 Mar;57(3):731-5. doi: 10.1016/0003-4975(94)90577-0.
We sought to reduce early ischemia-reperfusion injury after lung preservation by an initial brief period of hemodilute reperfusion. Left lungs of New Zealand White rabbits were ventilated with room air and reperfused in an ex vivo ventilation-perfusion apparatus after 18 hours of storage at 10 degrees C. Lungs were randomly assigned to one of three groups (n = 6) according to the composition of initial reperfusate. In group 1 (control), preserved lungs were reperfused with whole blood for 20 minutes (hematocrit, 38%). In the experimental groups, blood was diluted to a hematocrit of 10% with Ringer's lactate (group 2) or low-potassium-dextran solution (group 3) for the first 10 minutes of reperfusion, followed immediately by whole blood for 10 minutes. Oxygen tension of left ventricular effluent at the end of the 20-minute assessment period was significantly higher in both hemodiluted groups (mean +/- standard error of the mean: group 2, 81.3 +/- 6.6 mmHg; group 3, 77.0 +/- 9.5 mmHg, versus Group 1, 46.3 +/- 7.4 mmHg; p < 0.006). Similarly, mean tracheal airway pressure was reduced in the hemodiluted groups, suggesting improved compliance (group 2; 3.1 +/- 0.3 mmHg; group 3, 2.8 +/- 0.6 mmHg; versus group 1, 6.5 +/- 1.4 mm Hg; p < 0.05). An initial 10-minute period of hemodilute reperfusion appears to reduce early pulmonary ischemia-reperfusion injury in this 18-hour ex vivo rabbit lung preservation model.
我们试图通过最初短暂的血液稀释再灌注来减少肺保存后的早期缺血再灌注损伤。将新西兰白兔的左肺用室内空气通气，并在10℃储存18小时后，在体外通气灌注装置中进行再灌注。根据初始再灌注液的成分，将肺随机分为三组之一（n = 6）。在第1组（对照组）中，保存的肺用全血再灌注20分钟（血细胞比容为38%）。在实验组中，在再灌注的前10分钟用乳酸林格氏液（第2组）或低钾右旋糖酐溶液（第3组）将血液稀释至血细胞比容为10%，然后立即用全血再灌注10分钟。在20分钟评估期结束时，两个血液稀释组的左心室流出液氧分压均显著更高（平均值±平均标准误差：第2组，81.3±6.6 mmHg；第3组，77.0±9.5 mmHg，而第1组为46.3±7.4 mmHg；p < 0.006）。同样，血液稀释组的平均气管气道压力降低，提示顺应性改善（第2组；3.1±0.3 mmHg；第3组，2.8±0.6 mmHg；而第1组为6.5±1.4 mmHg；p < 0.05）。在这个18小时的体外兔肺保存模型中，最初10分钟的血液稀释再灌注似乎可减少早期肺缺血再灌注损伤。
