Pulmonary surfactant composition early in development of acute lung injury after cardiopulmonary bypass: prophylactic use of surfactant therapy.
Pulmonary surfactant composition early in development of acute lung injury after cardiopulmonary bypass: prophylactic use of surfactant therapy.
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体外循环后急性肺损伤发展早期的肺表面活性剂成分：表面活性剂治疗的预防性使用。
DOI：
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
T. Evans
中科院分区：
文献类型：
--
作者：
P. Haslam;C. Baker;D. A. Hughes;P. Macnaughton;N. Moat;A. Dewar;Anjna Aggarwal;T. Evans
心脏搭桥手术（CPB）导致肺损伤，至少2%的成人患者和更多的儿童发展为最严重的急性呼吸窘迫综合征（ARDS）。肺表面活性物质缺乏是ARDS的发病机制之一。有人提出，CPB后立即进行表面活性物质治疗可能会阻止进展为ARDS。然而，许多患者在体外循环后仅出现轻度肺损伤。因此，需要早期标记来识别那些风险最高的患者，以指导治疗选择。本研究的目的是确定是否发生表面活性磷脂的变化，并反映肺损伤的严重程度在转流后的最初几个小时内。由于成人患者中ARDS的发生率相对较低，因此本研究使用对旁路诱导肺损伤高度易感的幼猪进行。8只猪接受2小时的旁路。 6名对照接受了“假”旁路。在转流后3小时，通过放射性标记的转铁蛋白的跨毛细血管渗漏来评估肺血管内皮通透性。使用4小时支气管肺泡灌洗（BAL）评估肺泡内表面活性剂、炎性细胞和水肿蛋白水平。转流后肺氧合和肺顺应性福尔斯（P <0.01），但在肺损伤早期，肺泡表面活性物质磷脂和白蛋白水平在正常范围内，提示肺泡上皮尚未受到严重损害，主要异常是血管内皮通透性（P <0.01）、肺泡中性粒细胞（P <0.01）、总蛋白和鞘磷脂（P <0.05）增加。 肺组织学显示主要损害是位于细支气管及其相关血管周围的间质水肿。在5只动物中，单次滴注表面活性剂磷脂导致体内补充过量，并且没有减少早期病理生理变化。我们的研究结果表明，表面活性剂磷脂缺乏并没有作出重大贡献，在CPB后的肺损伤的初始阶段，在这个阶段，过量的磷脂补充可能是有害的。
Cardiopulmonary bypass surgery (CPB) causes lung injury and at least 2% of adult patients and more children develop the most severe form acute respiratory distress syndrome (ARDS). Pulmonary surfactant deficiency contributes to the pathogenesis of ARDS. It has been proposed that surfactant therapy immediately after CPB might arrest progression to ARDS. However, many patients develop only mild lung injury after CPB. Thus early markers are needed to identify those patients at highest risk to guide selection for treatment. The aim of this study was to determine whether changes in surfactant phospholipids occur, and reflect severity of lung injury within the first few hours after bypass. Because of the relatively low incidence of ARDS in adult patients, this study was conducted using young pigs highly susceptible to bypass‐induced lung injury. Eight pigs were given 2 hours bypass. Six controls underwent ‘sham’ bypass. At 3 h after bypass pulmonary vascular endothelial permeability was assessed by transcapillary leakage of radiolabelled transferrin. A 4 hour broncho‐alveolar lavage (BAL) was used to assess intra‐alveolar levels of surfactant, inflammatory cells and oedema protein. Bypass caused falls in arterial oxygenation and lung compliance (P < 0.01), but at this early stage in progression of lung injury BAL surfactant phospholipid and albumin levels were within the control range indicating that the alveolar epithelium had not yet suffered major damage.The main abnormalities were increases in vascular endothelial permeability (P < 0.01), BAL neutrophils (P < 0.01), total protein and sphingomyelin (SM) (P < 0.05). Lung histology showed that the main damage was interstitial oedema located around the bronchioles and their associated vessels. A single instilled dose of surfactant phospholipids in 5 animals caused excess in vivo supplementation and did not reduce the early pathophysiologic changes. Our findings suggest that surfactant phospholipid deficiency does not make a major contribution in the initial stages of lung injury after CPB, and that excessive phospholipid supplementation at this stage can be deleterious.
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影响因子：
15.9
作者：
HALLMAN, M;SPRAGG, R;GLUCK, L
通讯作者：
GLUCK, L
单板分离肺磷脂，包括二饱和磷脂酰胆碱。
影响因子：
6.5
作者：
Gilfillan,AM;Chu,AJ;Smart,DA;Rooney,SA
通讯作者：
Rooney,SA
白细胞消耗可改善体外循环后自由基介导的肺损伤。
DOI：
--
发表时间：
1990
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
--
作者：
Bando,K;Pillai,R;Cameron,DE;Brawn,JD;Winkelstein,JA;Hutchins,GM;Reitz,BA;Baumgartner,WA
通讯作者：
Baumgartner,WA
合成表面活性剂 (Exosurf) 抑制人肺泡巨噬细胞内毒素刺激的细胞因子分泌。
DOI：
10.1165/ajrcmb/7.3.257
发表时间：
1992
影响因子：
6.4
作者：
Thomassen,MJ;Meeker,DP;Antal,JM;Connors,MJ;Wiedemann,HP
通讯作者：
Wiedemann,HP
体外循环期间人中性粒细胞脱颗粒。
影响因子：
20.3
作者：
Wachtfogel,YT;Kucich,U;Greenplate,J;Gluszko,P;Abrams,W;Weinbaum,G;Wenger,RK;Rucinski,B;Niewiarowski,S;EdmundsJr,LH
通讯作者：
EdmundsJr,LH