Steen S, Ingemansson R, Budrikis A, Bolys R, Roscher R, Sjöberg T
Department of Cardiothoracic Surgery, University Hospital of Lund, Sweden.
Ann Thorac Surg. 1997 Feb;63(2):345-51. doi: 10.1016/s0003-4975(96)01101-0.
The aim of this study was to transplant lungs that had been topically cooled in the non-heart-beating donor for 6 hours, using the most challenging evaluation method possible, namely single-lung transplantation followed by immediate contralateral pneumonectomy.
Domestic pigs were used (6 donors and 6 recipients) with a mean body weight of 59 +/- 3 kg. Ventricular fibrillation was induced, and after 1 minute, cardiac massage was started and heparin (5 mg/kg body weight) was given via a central venous catheter. Cardiac massage was continued for 10 minutes, during which the pig was ventilated with 50% oxygen. The pleural cavities were opened and the tracheal tube disconnected from the ventilator, with the result that both lungs deflated. Saline slush was placed in both pleural cavities so that it completely covered the lungs. Within 40 minutes the lung core temperature was less than 10 degrees C, and it was kept around 8 degrees C for 6 hours by adjusting the amounts of ice slush. The left lung was then harvested and transplanted into a prepared recipient, followed by right pneumonectomy within 46 +/- 4 minutes, thus making the recipient pig 100% dependent on the transplanted cadaver lung.
The mean ischemic time for the cadaver lungs was 8 hours and 2 minutes (range, 7 hours and 25 minutes to 8 hours and 59 minutes). All animals remained in excellent condition throughout the 24-hour observation period, with arterial oxygen tensions of approximately 225 mm Hg, or 30 kPa (inspired oxygen fraction, 0.5).
Lungs from non-heart-beating donors may be used for transplantation if heparinization and topical cooling can be initiated within minutes of irreversible cardiac arrest.
本研究的目的是使用最具挑战性的评估方法，即单肺移植后立即进行对侧肺切除术，移植在非心跳供体中局部冷却6小时的肺。
使用家猪（6只供体和6只受体），平均体重为59±3千克。诱发心室颤动，1分钟后开始心脏按摩，并通过中心静脉导管给予肝素（5毫克/千克体重）。持续心脏按摩10分钟，在此期间用50%氧气对猪进行通气。打开胸腔，将气管导管与呼吸机断开，结果双肺萎陷。在双侧胸腔内放置盐水冻浆，使其完全覆盖肺部。40分钟内肺核心温度低于10摄氏度，并通过调整冰浆量使其在8摄氏度左右保持6小时。然后切取左肺并移植到准备好的受体中，在46±4分钟内进行右肺切除术，从而使受体猪100%依赖移植的尸体肺。
尸体肺的平均缺血时间为8小时2分钟（范围为7小时25分钟至8小时59分钟）。在整个24小时观察期内，所有动物状况良好，动脉血氧分压约为225毫米汞柱，即30千帕（吸入氧分数为0.5）。
如果在不可逆性心脏骤停后数分钟内开始肝素化和局部冷却，非心跳供体的肺可用于移植。
