常勇男
中国医学科学院阜外医院 麻醉科
BACKGROUND:The aim of this study was to evaluate the protective effect of pulmonary perfusion with hypothermic protective solution on lung function after cardiopulmonary bypass in corrections of Tetralogy of Fallot.METHODS:Sixty-four consecutive children with Tetralogy of Fallot were randomly divided into a control group (n = 30) and a protective group (n = 34). Hypothermic protective solution was infused to the main pulmonary artery in the protective group. Hemodynamics and lung functions were monitored. Concentrations of malondialdehyde, tumor necrosis factor-alpha, von Willebrand factor, and endothelin in plasma were measured. The interleukin-6 and interleukin-8 levels in bronchoalveolar lavage fluid were also determined. Lung biopsy specimens were obtained after weaning from cardiopulmonary bypass.RESULTS:Oxygenation values (oxygen index and alveolar-arterial O(2) gradient) were better preserved in the protective group than in the control group. The time of mechanical ventilation and length of intensive care unit stay were shorter in the protective group compared with the control group. The tumor necrosis factor-alpha and malondialdehyde levels in plasma increased in both groups after operations, and the rising extents were lower in the protective group than in the control group. The von Willebrand factor and endothelin levels in plasma increased more significantly in the control group than in the protective group. The concentrations of interleukin-6 and interleukin-8 in bronchoalveolar lavage fluid were lower in the protective group than in the control group. The examination of histopathology demonstrated capillary hyperemia and hemorrhage, intra-alveolar edema, leukocytes accumulation, mitochondria swelling and vacuolation, and gas-blood barrier broadening in the control group, whereas there were no significant changes in the protective group. The intercellular adhesion molecule-1 expression on lung vascular endothelial cells was stronger in the control group.CONCLUSIONS:Lung perfusion with hypothermic protective solution during cardiopulmonary bypass relieved lung injury in corrections of Tetralogy of Fallot. The inhibition of lung vascular endothelial cell injury may be the major mechanism of relieving cardiopulmonary bypass-induced lung injury.
The Annals of thoracic surgery 2004
OBJECTIVE:To study effects of pulmonary artery perfusion with hypothermic solution on the apoptosis of lung parenchymal cells during cardiopulmonary bypass.METHODS:Forty children with tetralogy of Fallot were divided into control group (n = 20) and protective group (n = 20). The patients in control group were performed using routine approaches. Patients' pulmonary artery were infused with 4 degrees C protective solution during cardiopulmonary bypass in protective group. Lung biopsy specimens were obtained after operations in order to study the apoptosis of lung parenchymal cells using tunnel techniques. At same time, patients' pulmonary functions and clinic index were monitored.RESULTS:The rate of apoptosis cells of lung parenchymal cells was (18 +/- 7)% in control group, whereas (10 +/- 2)% in protective group. There was significant difference between both groups (t = -2.95, P < 0.05). Index O(2) in protective group was higher than that in control group at 0, 6 and 12 hours after operations [(492 +/- 172), (444 +/- 104), (489 +/- 58) mm Hg versus (369 +/- 126), (347 +/- 107), (340 +/- 119) mm Hg, t = 2.59, P < 0.05; t = 2.88, P < 0.01; t = 5.06, P < 0.01, respectively)]. The time of mechanical ventilation was significantly shorter in protective group than in control group [(15 +/- 11) hours versus (26 +/- 15) hours, t = -2.76, P < 0.01].CONCLUSION:Pulmonary artery perfusion with hypothermic solution can inhibit the apoptosis of lung parenchymal cells and relieve cardiopulmonary bypass-induced lung injury.
Zhonghua wai ke za zhi [Chinese journal of surgery] 2004
OBJECTIVE:To study lung protection by perfusion with hypothermic protective solution to the pulmonary artery during total correction of tetralogy of Fallot (TOF).METHODS:Sixty-four consecutive children with TOF were randomly divided into control group (n = 30) and lung protective group (n = 34). The way of lung protection in the lung protective group was to perfuse with hypothermic protective solution to the pulmonary artery. Patients in the control group were subjected to routine approach. Patients' hemodynamics and lung functions were monitored. Plasma malondialdehyde (MDA), TNF-alpha and IL-6, IL-8 in tracheal suction were measured. Lung biopsy specimens were obtained after operations to study histological changes.RESULTS:The oxygen index was higher in the lung protect group than in the control group at 6 h, 12 h and 24 h after operation (t = 2.400, P < 0.05; t = 3.898, P < 0.01; t = 3.339, P < 0.01, respectively). The time for ICU and mechanical ventilation was significantly less in the lung protective group than in the control group (t = -2.652, P < 0.05; t = -2.081, P < 0.05). The level of MDA was lower in the lung protective group than in the control group at 0 h and 6 h after operations (t = -4.255, P < 0.01; t = -2.372, P < 0.05 respectively). The level of TNF-alpha was lower in the lung protective group than in the control group at 0 h, 6 h and 24 h after operation (t = 3.112, P < 0.01; t = 3.072, P < 0.01; t = 2.306, P < 0.05, respectively). The levels of IL-6, IL-8 in tracheal suction were lower in the lung protective group (t = -2.419, P < 0.05; t = -2.613, P < 0.01). Tissue examination showed intraalveolar edema, capillary hyperemia, leukocytes accumulated, and mitochondria swelling in the control group, whereas no change in the lung protective group.CONCLUSION:Perfusion with hypothermic protective solution to the pulmonary artery in CPB could reduce lung injury during the total correction of TOF.
Zhonghua wai ke za zhi [Chinese journal of surgery] 2002
