Yamashita M, Schmid R A, Ando K, Cooper J D, Patterson G A
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Ann Thorac Surg. 1996 Sep;62(3):791-6; discussion 796-7. doi: 10.1016/s0003-4975(96)00439-0.
Nitric oxide is believed to play a critical role in the maintenance of vascular integrity through its interaction with neutrophils, platelets, and cellular components of the vessel wall. It has been reported that endogenous nitric oxide level was depressed after ischemia, reperfusion, or both. Furthermore, exogenous as well as endogenous nitric oxide decreases reperfusion-induced vascular dysfunction. We hypothesized that nitroprusside, a potent nitric oxide donor, might enhance lung preservation and reduce posttransplantation lung allograft dysfunction.
Ten dogs underwent left lung allotransplantation. Donor lungs were flushed with modified Euro-Collins solution and stored for 21 hours at 1 degree C. Immediately after transplantation, the contralateral right main pulmonary artery and bronchus were ligated to assess isolated allograft function. Hemodynamics and arterial blood gas analysis (inspired oxygen fraction, 1.0) were assessed for 6 hours before sacrifice. Allograft myeloperoxidase activity and wet-to-dry weight ratio were assessed. Group 1 (n = 5) animals received no nitroprusside. In group 2 (n = 5), the donor lung received nitroprusside in the flush solution (10 mg/L) and recipient animals received 0.2 mg/kg just before reperfusion as well as a continuous infusion (0.11 +/- 0.01 mg.kg-1. h-1) during the assessment period.
Superior gas exchange and hemodynamics were noted in lungs receiving nitroprusside. Although allograft myeloperoxidase activity and the total amount of fluid suctioned from the allograft were significantly reduced in group 2, protein levels in bronchoalveolar lavage fluid were not statistically different.
Nitroprusside administration in the flush solution and during reperfusion improves lung allograft function and blood flow, and reduces pulmonary vascular resistance and myeloperoxidase activity in the transplanted lung. Nitroprusside reduces lung allograft reperfusion injury.
一氧化氮被认为通过与中性粒细胞、血小板及血管壁细胞成分相互作用，在维持血管完整性方面发挥关键作用。据报道，缺血、再灌注或两者兼有的情况下，内源性一氧化氮水平会降低。此外，外源性及内源性一氧化氮均可减轻再灌注诱导的血管功能障碍。我们推测硝普钠，一种强效一氧化氮供体，可能会增强肺保存效果并减少移植后肺同种异体移植物功能障碍。
十只犬接受左肺同种异体移植。供体肺用改良的欧洲柯林斯溶液冲洗，并在1℃下保存21小时。移植后立即结扎对侧右主肺动脉和支气管，以评估孤立的同种异体移植物功能。在处死前6小时评估血流动力学和动脉血气分析（吸入氧分数为1.0）。评估同种异体移植物髓过氧化物酶活性和湿重与干重比。第1组（n = 5）动物未接受硝普钠。在第2组（n = 5）中，供体肺在冲洗液中接受硝普钠（10 mg/L），受体动物在再灌注前接受0.2 mg/kg，并且在评估期间接受持续输注（0.11±0.01 mg·kg-1·h-1）。
接受硝普钠的肺中气体交换和血流动力学更佳。虽然第2组同种异体移植物髓过氧化物酶活性和从同种异体移植物中吸出的液体总量显著降低，但支气管肺泡灌洗中的蛋白质水平无统计学差异。
在冲洗液中和再灌注期间给予硝普钠可改善肺同种异体移植物功能和血流，降低移植肺的肺血管阻力和髓过氧化物酶活性。硝普钠可减轻肺同种异体移植物再灌注损伤。
