Buchanan S A, Mauney M C, Parekh V I, DeLima N F, Binns O A, Cope J T, Shockey K S, Tribble C G, Kron I L
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Ann Thorac Surg. 1996 Dec;62(6):1617-21. doi: 10.1016/s0003-4975(96)00612-1.
Decreased airway compliance after lung transplantation has been observed with severe ischemia-reperfusion injury. Further, it has been shown that the surfactant system is impaired after lung preservation and reperfusion. We hypothesized that surfactant replacement after allograft storage could preserve airway compliance during reperfusion.
Rabbit lungs were harvested after flush with 50 mL/kg of cold saline solution. Immediate control lungs were studied with an isolated ventilation/perfusion apparatus using venous rabbit blood recirculated at 40 mL/min, room-air ventilation at 20 breaths/min, and constant airway pressure (n = 8). Twenty-four-hour control lungs were preserved at 4 degrees C for 24 hours and then similarly studied (n = 7). Surfactant lungs underwent similar harvest and preservation for 24 hours, but received 1.5 mL/kg of intratracheal surfactant 5 minutes before reperfusion (n = 10). Airway pressure and flow were recorded continuously during 30 minutes of reperfusion. Tidal volume and airway compliance were calculated at 30 minutes.
Tidal volume was 33.67 +/- 0.57, 15.75 +/- 5.72, and 29.83 +/- 1.07 mL in the immediate control, 24-hour control, and surfactant groups, respectively (p = 0.004, surfactant versus 24-hour control). Airway compliance was 1.94 +/- 0.27, 0.70 +/- 0.09, and 1.46 +/- 0.10 mL/mm Hg in the immediate control, 24-hour control, and surfactant groups, respectively (p = 0.002, surfactant versus 24-hour control).
We conclude that surfactant administration before reperfusion after 24 hours of cold storage preserves tidal volume and airway compliance in the isolated ventilated/perfused rabbit model of lung reperfusion injury.
肺移植后气道顺应性降低与严重的缺血再灌注损伤有关。此外，研究表明肺保存和再灌注后表面活性剂系统受损。我们推测同种异体移植保存后给予表面活性剂替代物可在再灌注期间维持气道顺应性。
用50 mL/kg冷盐水溶液冲洗后摘取兔肺。立即将对照肺用离体通气/灌注装置进行研究，使用兔静脉血以40 mL/min再循环，室内空气以20次/分钟通气，并保持气道压力恒定（n = 8）。24小时对照肺在4℃保存24小时，然后进行类似研究（n = 7）。表面活性剂组肺进行类似的摘取和保存24小时，但在再灌注前5分钟给予1.5 mL/kg气管内表面活性剂（n = 10）。在再灌注30分钟期间连续记录气道压力和流量。在30分钟时计算潮气量和气道顺应性。
立即对照、24小时对照和表面活性剂组的潮气量分别为33.67±0.57、15.75±5.72和29.83±1.07 mL（p = 0.004，表面活性剂组与24小时对照组相比）。立即对照、24小时对照和表面活性剂组的气道顺应性分别为1.94±0.27、0.70±0.09和1.46±0.10 mL/mm Hg（p = 0.002，表面活性剂组与24小时对照组相比）。
我们得出结论，在兔肺再灌注损伤的离体通气/灌注模型中，冷保存24小时后再灌注前给予表面活性剂可维持潮气量和气道顺应性。
