COMBINED EXOGENOUS SURFACTANT AND INHALED NITRIC OXIDE THERAPY FOR LUNG ISCHEMIA-REPERFUSION INJURY IN MINIPIGS1
COMBINED EXOGENOUS SURFACTANT AND INHALED NITRIC OXIDE THERAPY FOR LUNG ISCHEMIA-REPERFUSION INJURY IN MINIPIGS1
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外源性表面活性剂和吸入一氧化氮联合治疗小型猪肺缺血再灌注损伤1
作者：
G. Warnecke;M. Struber;S. Fraund;J. Hohlfeld;A. Haverich
背景观察外源性肺表面活性物质联合吸入一氧化氮对肺缺血再灌注损伤的保护作用。方法.用冷保存液对18只小型猪左肺进行原位选择性灌注。热缺血90 min后，再灌注肺，结扎右肺动脉和支气管（对照组，n=6）。表面活性物质组（n=6）在缺血时经支气管镜注入外源性表面活性物质。在第三组中，应用表面活性剂，然后吸入一氧化氮（表面活性剂+NO组，n=6）。血流动力学和呼吸参数记录7小时，并获得支气管肺泡灌洗液（BALF）前和再灌注后的表面张力，小聚集体/大聚集体的比例，蛋白质和磷脂含量的测量，和微分细胞计数。结果对照组动物存活3.7±1.4小时。在两个表面活性剂处理组中，6只动物中有5只在观察期内存活（P <0.001）。对照组肺动态顺应性降低（P <0.001）。肺表面活性物质+一氧化氮组动脉血氧分压明显高于其他两组（P <0.001）。BALF细胞计数和组织学显示在表面活性剂+NO处理的肺中中性粒细胞浸润减少。用脉动气泡表面张力计在对照动物中评估的BALF中的表面张力严重受损（min，14.82±9.95 mN/m），但在表面活性剂处理的动物（min，1.11±0.56 mN/m）和表面活性剂+NO处理的动物（min，3.90±2.35 mN/m，P =0.02）中维持。结论.外源性肺表面活性物质治疗肺再灌注损伤可改善肺顺应性。与单独表面活性剂治疗相比，吸入NO可改善动脉氧合，减少中性粒细胞外渗。
Background. The combined application of exogenous surfactant and inhaled nitric oxide was evaluated for prevention of ischemia-reperfusion injury of the lung. Methods. Left lungs were selectively perfused in 18 minipigs in situ with cold preservation solution. After 90 min of warm ischemia, the lungs were reperfused and the right pulmonary artery and bronchus were ligated (control group, n=6). Exogenous surfactant was instilled via bronchoscopy during ischemia (surfactant group, n=6). In a third group, surfactant was applied, followed by administration of inhaled nitric oxide (surfactant+NO group, n=6). Hemodynamic and respiratory parameters were recorded for 7 hr, and bronchoalveolar lavage fluid (BALF) was obtained before and after reperfusion for measurement of surface tension, small aggregate/large aggregate ratio, protein and phospholipid contents, and a differential cell count. Results. Control group animals survived for 3.7±1.4 hr. In both surfactant-treated groups, five out of six animals survived the observation period (P <0.001). Dynamic compliance of the lung was decreased in control animals (P <0.001). In the surfactant+NO group, arterial PO2 was higher than in both other groups (P <0.001). BALF cell count and histology showed reduced neutrophil infiltration in surfactant+NO-treated lungs. Surface tension assessed in BALF with a pulsating bubble surfactometer was severely impaired in control animals (&ggr;min, 14.82±9.95 mN/m), but maintained in surfactant-treated (&ggr;min, 1.11±0.56 mN/m) and surfactant+NO-treated animals (&ggr;min, 3.90±2.35 mN/m, P =0.02). Conclusions. Administration of exogenous surfactant in lung reperfusion injury results in improved lung compliance. The addition of inhaled NO improves arterial oxygenation and reduces neutrophil extravasation compared with surfactant treatment alone.
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离体缺血和缺氧灌注大鼠心脏内皮功能障碍的时间过程和机制。
DOI：
10.1152/ajpheart.1990.259.6.h1660
发表时间：
1990
期刊：
The American journal of physiology
影响因子：
--
作者：
Tsao,PS;Lefer,AM
通讯作者：
Lefer,AM
DOI：
10.1073/pnas.88.11.4651
发表时间：
1991-06-01
影响因子：
11.1
作者：
KUBES, P;SUZUKI, M;GRANGER, DN
通讯作者：
GRANGER, DN
小剂量硝普钠可减轻肺再灌注损伤。
DOI：
10.1016/s0003-4975(97)00250-6
发表时间：
1997
期刊：
The Annals of thoracic surgery
影响因子：
--
作者：
King,RC;Binns,OA;Kanithanon,RC;Cope,JT;Chun,RL;Shockey,KS;Tribble,CG;Kron,IL
通讯作者：
Kron,IL
影响因子：
158.5
作者：
ROSSAINT, R;FALKE, KJ;ZAPOL, WM
通讯作者：
ZAPOL, WM
影响因子：
2.2
作者：
EPPINGER, MJ;JONES, ML;WARD, PA
通讯作者：
WARD, PA