Hepatic cryoablation-induced acute lung injury -: Pulmonary hemodynamic and permeability effects in a sheep model
Hepatic cryoablation-induced acute lung injury -: Pulmonary hemodynamic and permeability effects in a sheep model
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DOI：
10.1001/archsurg.135.6.667
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发表时间：
2000-06-01
影响因子：
--
通讯作者：
Parker, RE
中科院分区：
文献类型：
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作者：
Chapman, WC;Debelak, JP;Parker, RE
假设：绵羊模型中30%至35%或更多肝实质的肝冷冻消融导致类花生酸和核因子-κ B（NF-κ B）介导的肺血流动力学和肺通透性的变化。设置：实验室。干预：在最初的开胸手术中，将导管放置在主肺动脉、左心房、右颈动脉，和输出管的尾部纵隔淋巴结的后续监测在成年绵羊。经过1- 2周的恢复期后，动物接受剖腹手术和左叶冷冻消融术（约35%体积），随后在术后第1 - 3天进行清醒监测。主要结果测量：冷冻消融诱导的肺通透性和血流动力学变化与接受器械的绵羊的基线值进行比较。类似处理的绵羊接受了类似体积的肝实质切除或机械性左心房阻塞诱导的肺动脉压力升高。用电泳迁移率变化分析和血清血栓素测定评估NF-κ B B的活化。结果：冷冻消融导致平均肺（20至35 cm水柱）和全身压力急性升高，24小时恢复至基线水平，心输出量无变化。冷冻消融后30分钟血清血栓素水平升高（9倍），24小时恢复至基线水平。冷冻消融后30分钟，肝和肺组织中存在NF-κ B活化。肺淋巴血浆蛋白清除率明显超过了单纯肺动脉压的预期增加，肺动脉压正常后淋巴血浆蛋白释放率持续增加。类似的变化与35% hepatic secrety.Conclusions：这项研究表明，35%肝冷冻消融导致急性但短暂的肺动脉压增加，可能是由血栓素水平增加介导的。肺毛细血管通透性的增加不能仅由压力变化来解释，可能是NF-κ B介导的炎症机制的结果。这些数据表明，冷冻手术引起的病理生理变化与内毒素和其他全身炎症刺激所观察到的相似。
Hypothesis: Hepatic cryoablation of 30% to 35% or more of liver parenchyma in a sheep model results in eicosanoid and nuclear factor-kappa B (NF-kappa B)-mediated changes in pulmonary hemodynamics and lung permeability.Setting: Laboratory.Interventions: At initial thoracotomy, catheters were placed in the main pulmonary artery, left atrium, right carotid artery, and efferent duct of the caudal mediastinal lymph node for subsequent monitoring in adult sheep. After a 1- to 2-week period of recovery, animals underwent laparotomy and left-lobe cryoablation (approximately 35% by volume) with subsequent awake monitoring and on postoperative days 1 to 3.Main Outcome Measures: Cryoablation-induced lung permeability and hemodynamic changes were compared with baseline values in sheep that underwent instrumentation. Similarly handled sheep underwent resection of a similar volume of hepatic parenchyma or had pulmonary artery pressure increases induced by mechanical left atrial obstruction. Activation of NF-kappa B was assessed with electrophoretic mobility shift assay, and serum thromboxaneResults: Cryoablation resulted in acutely increased mean pulmonary (20 to 35 cm water) and systemic pressures, which returned to baseline at 24 hours with no change in cardiac output. Serum thromboxane levels increased 30 minutes after cryoablation (9-fold) and returned to baseline at 24 hours. Activation of NF-kappa B was present in liver and lung tissue by 30 minutes after cryoablation. Lung lymph-plasma protein clearance markedly exceeded the expected increase from pulmonary pressures alone, and increased lymph-plasma pro rein ra tio persisted after pulmonary artery pressures normalized. Similar changes were not associated with 35% hepatic resection.Conclusions: This study demonstrates that 35% hepatic cryoablation results in an acute but transient increase in pulmonary artery pressure that may be mediated by increased thromboxane levels. Increases in pulmonary capillary permeability are not accounted for by pressure changes alone, and may be a result of NF-kappa B-mediated inflammatory mechanisms. These data show that cryosurgery causes pathophysiological changes similar to those observed with endotoxin and other systemic inflammatory stimuli.