Friedman-Mor Z, Chalon J, Turndorf H, Orkin L R
J Trauma. 1976 Oct;16(10):815-8.
We previously reported (1) that tracheobronchial secretions of patients in hemorrhagic shock contained significantly more iron laden histiocytes than secretions of matched controls and demonstrated by histiologic studies in rats bled to hemorrhagic shock that these animals' lungs contained significantly more iron laden histiocytes than those of a control group. Two explanations appeared plausible: 1) abnormal hemoglobin breakdown products of systemic hypoperfusion during shock (2, 3, 5) may have accumulated in the pulmonary circulation where they were phagocytozed by pulmonary histiocytes, or 2) circulating iron laden histiocytes may have been arrested in the lung, which is well known to act as a filter during low-flow states (4). The present study reports on assay of bronchial secretions of 12 open-heart surgery patients under cardiopulmonary bypass from specimens obtained 1) immediately after onset of anesthesia; 2) during; and 3) after termination of cardiopulmonary bypass. The percentage of iron laden histiocytes rose from 15.6+/-6.0 after intubation, to 49.6+/-6.8 after 1 hour on bypass with occluded pulmonary arteries (p less than 0.0025), remaining close to the latter value after pulmonary circulation was restored. Hypoperfusion, accumulation of metabolites, or falling pH at the tissue level are probable explanations for these findings.
我们之前报道过(1)，失血性休克患者的气管支气管分泌物中含铁血巨噬细胞显著多于配对对照组的分泌物，并且通过对失血性休克大鼠的组织学研究表明，这些动物肺中的含铁血巨噬细胞显著多于对照组。有两种解释似乎合理：1) 休克期间全身低灌注产生的异常血红蛋白分解产物(2, 3, 5)可能在肺循环中积聚，在那里被肺巨噬细胞吞噬，或者2) 循环中的含铁血巨噬细胞可能在肺中滞留，众所周知，在低流量状态下肺起到过滤器的作用(4)。本研究报告了对12例体外循环心脏直视手术患者支气管分泌物的检测，标本取自：1) 麻醉开始后立即；2) 体外循环期间；3) 体外循环结束后。含铁血巨噬细胞的百分比从插管后的15.6±6.0上升到肺动脉闭塞体外循环1小时后的49.6±6.8(p<0.0025)，肺循环恢复后仍接近后者的值。组织水平的低灌注、代谢产物积聚或pH值下降可能是这些发现的原因。
