Lowering reperfusion pressure reduces the injury after pulmonary ischemia

被引:39
作者
Halldorsson, AO
Kronon, MT
Allen, BS
Rahman, S
Wang, TR
机构
[1] Hope Childrens Hosp, Heart Inst Children, Div Cardiothorac Surg, Oak Lawn, IL 60453 USA
[2] Univ Chicago, Chicago, IL 60637 USA
关键词
D O I
10.1016/S0003-4975(99)01104-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Controlled reperfusion with a modified solution limits pulmonary injury following ischemia. Our initial studies infused this modified reperfusate at a pressure of 40 to 50 mm Hg to insure distribution. However, perhaps a lower pressure, which is closer to the normal physiologic pressure in the lung, would improve results by decreasing sheer stress. Methods. Fifteen adult pigs underwent 2 hours of lung ischemia by clamping the left bronchus and pulmonary artery. Five (group 1) then underwent uncontrolled reperfusion by removing the vascular clamps and allowing unmodified blood to reperfuse the lung at a pulmonary artery pressure of 20 to 30 mm Hg. The other 10 pigs underwent controlled reperfusion by mixing blood from the femoral artery with a crystalloid solution, and infusing this modified reperfusate into the ischemic lung through the pulmonary artery for 10 minutes before removing the arterial clamp. In 5 (group 2), the modified solution was infused at a pressure of 40 to 50 mm Hg, and in 5 (group 3) 20 to 30 mm Hg. Lung function was assessed 60 minutes after reperfusion and expressed as percentage of control. Results. Compared to uncontrolled reperfusion (group 1), controlled reperfusion at a pressure of 40 to 50 mm Hg (group 2) significantly improved postreperfusion pulmonary compliance (77% versus 86%; p < 0.001 versus group 1), and arterial/alveolar ratio (a/A) ratio (27% versus 52%; p < 0.001 versus group 1); as well as decreased pulmonary vascular resistance (PVR) (198% versus 154%; p < 0.001 versus group 1), lung water (84.3% versus 83.5%; p < 0.001 versus group 1), and myeloperoxidase (0.35 versus 0.23 optical density/min/mg protein). Reducing the pressure of the modified reperfusate to 20 to 30 mm Hg further improved postreperfusion compliance (92% +/- 1%; p < 0.001 versus groups 1 and 2) and a/A ratio (76% +/- 1%; p < 0.001 versus groups 1 and 2); and lowered PVR (133% +/- 2%; p < 0.001 versus groups 1 and 2), lung water (82.7% +/- 0.1%; p < 0.001 versus groups 1 and 2), and myeloperoxidase (0.16% +/- 0.01%; p < 0.001 versus groups 1 and 2). Conclusions. After 2 hours of pulmonary ischemia, a severe lung injury occurs following uncontrolled reperfusion, controlled reperfusion with a modified solution reduces this reperfusion injury, and lowering the pressure of the modified reperfusate to more physiologic levels (20 to 30 mm I-Ig) further reduces the reperfusion injury improving pulmonary function. (C) 2000 by The Society of Thoracic Surgeons.
引用
收藏
页码:198 / 203
页数:6
相关论文
共 23 条
[1]  
ALLEN BS, 1986, J THORAC CARDIOV SUR, V92, P621
[2]  
ALLEN BS, 1993, J THORAC CARDIOV SUR, V105, P864
[3]   Critical importance of the first 10 minutes of lung graft reperfusion after hypothermic storage [J].
Bhabra, MS ;
Hopkinson, DN ;
Shaw, TE ;
Hooper, TL .
ANNALS OF THORACIC SURGERY, 1996, 61 (06) :1631-1635
[4]   Controlled reperfusion protects lung grafts during a transient early increase in permeability [J].
Bhabra, MS ;
Hopkinson, DN ;
Shaw, TE ;
Onwu, N ;
Hooper, TL .
ANNALS OF THORACIC SURGERY, 1998, 65 (01) :187-192
[5]  
Boyle EM, 1997, ANN THORAC SURG, V63, P277
[6]  
Buckberg G.D., 1995, GLENNS THORACIC CARD, P1653
[7]   PULMONARY TRANSPLANTATION [J].
DAVIS, RD ;
PASQUE, MK .
ANNALS OF SURGERY, 1995, 221 (01) :14-28
[8]   COLD ISCHEMIA AND REPERFUSION EACH PRODUCE PULMONARY VASOMOTOR DYSFUNCTION IN THE TRANSPLANTED LUNG [J].
FULLERTON, DA ;
MITCHELL, MB ;
MCINTYRE, RC ;
BANERJEE, A ;
CAMPBELL, DN ;
HARKEN, AH ;
GROVER, FL .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1993, 106 (06) :1213-1217
[9]   TRANSIENT ULTRASTRUCTURAL INJURY AND REPAIR OF PULMONARY CAPILLARIES IN TRANSPLANTED RAT LUNG - EFFECT OF PRESERVATION AND REPERFUSION [J].
HALL, SM ;
ODOM, N ;
MCGREGOR, CGA ;
HAWORTH, SG .
AMERICAN JOURNAL OF RESPIRATORY CELL AND MOLECULAR BIOLOGY, 1992, 7 (01) :49-57
[10]   Controlled reperfusion after lung ischemia: Implications for improved function after lung transplantation [J].
Halldorsson, A ;
Kronon, M ;
Allen, BS ;
Bolling, KS ;
Wang, TR ;
Rahman, S ;
Feinberg, H .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1998, 115 (02) :415-424