Binns O A, DeLima N F, Buchanan S A, Cope J T, King R C, Marek C A, Shockey K S, Tribble C G, Kron I L
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
J Thorac Cardiovasc Surg. 1996 Dec;112(6):1515-21. doi: 10.1016/S0022-5223(96)70010-7.
Lung transplantation remains limited by donor organ ischemic time, inadequate graft preservation, and reperfusion injury. We evaluated lung preservation with use of an extracellular solution, with or without the addition of blood, as compared with preservation with the intracellular Euro-Collins solution.
With use of an isolated, whole blood perfused/ventilated rabbit lung model, we studied three groups of animals. Lungs were flushed with Euro-Collins, low-potassium dextran, or 20% blood-low-potassium dextran solution. Lungs were harvested en bloc, stored inflated at 4 degrees C for 18 hours, and then reperfused at 60 ml/min with whole blood. Continuous measurements of pulmonary artery pressure, pulmonary vascular resistance, and dynamic airway compliance were obtained. Fresh, nonrecirculated venous blood was used to determine the single-pass pulmonary venous-arterial oxygen gradient.
Lungs preserved with Euro-Collins solution demonstrated elevated pulmonary artery pressure and pulmonary vascular resistance when compared with those preserved with low-potassium dextran and 20% blood-low-potassium dextran solutions (pulmonary artery pressure: 40.8 +/- 2.2 mm Hg vs 28.9 +/- 2.4 mm Hg and 28.3 +/- 1.5 mm Hg, respectively, p < 0.001; pulmonary vascular resistance: 46.0 +/- 3.1 x 10(3) dynes x sec x cm(-5) vs 29.0 +/- 4.2 x 10(3) dynes x sec x cm(-5) and 28.8 +/- 2.3 x 10(3) dynes x sec x cm(-5), respectively, p < 0.001). Euro-Collins solution-preserved lungs demonstrated a significant drop in compliance when compared with those preserved with low-potassium dextran and 20% blood-low-potassium dextran (-21.9% +/- 4.7% vs 1.8% +/- 3.3% and 1.4% +/- 6.2%, respectively; p = 0.002). Oxygenation was improved with low-potassium dextran and 20% blood-low-potassium dextran solutions as compared with that with Euro-Collins solution (296.3 +/- 54.6 mm Hg and 290.2 +/- 66.4 mm Hg, respectively, vs 37.2 +/- 4.6 mm Hg; p = 0.001).
Extracellular solutions provided superior preservation of pulmonary function in this rabbit lung model of ischemia-reperfusion. However, the addition of blood does not confer any demonstrable advantage over low-potassium dextran solution alone with use of an 18-hour period of cold ischemia.
肺移植仍然受到供体器官缺血时间、移植物保存不充分及再灌注损伤的限制。我们评估了使用细胞外溶液（添加或不添加血液）进行肺保存，并与使用细胞内欧洲柯林斯溶液进行保存相比较。
使用一个离体的、全血灌注/通气的兔肺模型，我们研究了三组动物。肺用欧洲柯林斯溶液、低钾右旋糖酐溶液或20%血液-低钾右旋糖酐溶液冲洗。将肺整块取出，在4℃充气保存18小时，然后以60ml/min的速度用全血进行再灌注。连续测量肺动脉压、肺血管阻力和动态气道顺应性。使用新鲜的、未再循环的静脉血来测定单通道肺静脉-动脉氧梯度。
与用低钾右旋糖酐溶液和20%血液-低钾右旋糖酐溶液保存的肺相比，用欧洲柯林斯溶液保存的肺显示肺动脉压和肺血管阻力升高（肺动脉压：分别为40.8±2.2mmHg、28.9±2.4mmHg和28.3±1.5mmHg，p<0.001；肺血管阻力：分别为46.0±3.1×10(3)达因×秒×厘米(-5)、29.0±4.2×10(3)达因×秒×厘米(-5)和28.8±2.3×10(3)达因×秒×厘米(-5)，p<0.001）。与用低钾右旋糖酐溶液和20%血液-低钾右旋糖酐溶液保存的肺相比，用欧洲柯林斯溶液保存的肺顺应性显著下降（分别为-21.9%±4.7%、1.8%±3.3%和1.4%±6.2%；p=0.002）。与欧洲柯林斯溶液相比，低钾右旋糖酐溶液和20%血液-低钾右旋糖酐溶液使氧合得到改善（分别为296.3±54.6mmHg和290.2±66.4mmHg，相比之下为37.2±4.6mmHg；p=0.001）。
在这个兔肺缺血-再灌注模型中，细胞外溶液能更好地保存肺功能。然而，在18小时的冷缺血期使用时，添加血液并不比单独使用低钾右旋糖酐溶液有任何明显优势。
