在肺移植手术时吸入一氧化氮可改善早期肺移植功能。

Inhaled nitric oxide at the time of harvest improves early lung allograft function.

作者信息

Fujino S, Nagahiro I, Triantafillou A N, Boasquevisque C H, Yano M, Cooper J D, Patterson G A

机构信息

Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, Missouri, USA.

出版信息

Ann Thorac Surg. 1997 May;63(5):1383-9; discussion 1390. doi: 10.1016/s0003-4975(97)00236-1.

DOI:10.1016/s0003-4975(97)00236-1

PMID:9146331

Abstract

BACKGROUND

Inhalation of nitric oxide (NO) has been shown to have beneficial effects on a variety of acute lung injuries, including lung allograft reperfusion injury. The purpose of the present study was to investigate the effects of inhaled NO at the time of harvest on function of canine left lung allografts after transplantation.

METHODS

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 main pulmonary artery and bronchus were ligated to assess isolated allograft function. Hemodynamics and arterial blood gases (inspired oxygen fraction, 1.0) were assessed intermittently for 6 hours prior to sacrifice. Allograft myeloperoxidase activity and wet to dry weight ratio were assessed. Donor animals were divided into two groups. Group I animals (n = 5) received no NO. In group II (n = 5), donors received inhaled NO (60 ppm) at the time of harvest.

RESULTS

Pulmonary vascular resistance decreased to 79.6% of baseline because of inhalation of 60 ppm NO in group II donor animals. Thiobarbituric acid-reactive materials were reduced during the storage period in group II, a finding suggesting less oxidant injury during storage in donor lungs treated with NO. Throughout the 6-hour assessment, oxygenation in group II was superior to that in group I (p < 0.05). At 360 minutes of assessment, mean arterial oxygen tension in groups I and II was 88.9 +/- 11.4 mm Hg and 169.1 +/- 33.0 mm Hg, respectively. Myeloperoxidase activity was significantly decreased in group II (p < 0.05), data indicating reduced neutrophil sequestration. Wet to dry weight ratio was significantly lower in group II.

CONCLUSIONS

These data suggest that inhaled NO at the time of harvest improves early function of preserved lung allografts by attenuating oxidant injury during storage and subsequent neutrophil sequestration.

摘要

背景

吸入一氧化氮（NO）已被证明对包括肺移植再灌注损伤在内的多种急性肺损伤具有有益作用。本研究的目的是探讨在收获时吸入NO对犬左肺移植后同种异体移植物功能的影响。

方法

10只犬接受左肺同种异体移植。供体肺用改良的Euro-Collins溶液冲洗，并在1℃下保存21小时。移植后立即结扎对侧主肺动脉和支气管，以评估孤立的同种异体移植物功能。在处死前6小时间歇性评估血流动力学和动脉血气（吸入氧分数，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。供体动物分为两组。I组动物（n = 5）未接受NO。在II组（n = 5）中，供体在收获时接受吸入NO（60 ppm）。

结果

由于II组供体动物吸入60 ppm NO，肺血管阻力降至基线的79.6%。II组在储存期间硫代巴比妥酸反应性物质减少，这一发现表明在用NO处理的供体肺储存期间氧化损伤较小。在整个6小时的评估中，II组的氧合优于I组（p < 0.05）。在评估360分钟时，I组和II组的平均动脉氧分压分别为88.9±11.4 mmHg和169.1±33.0 mmHg。II组髓过氧化物酶活性显著降低（p < 0.05），数据表明中性粒细胞滞留减少。II组的湿重与干重比显著较低。