权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Modified low-flow ultrafiltration ameliorates hemodynamics and early graft function and reduces blood loss in living-donor lobar lung transplantation

改良低流量超滤可改善血流动力学和早期移植物功能，并减少活体肺叶移植中的失血量

基本信息

批准号：
18591704
负责人：
GOTO Keiji
金额：
$ 2万
依托单位：
Okayama University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2006
资助国家：
日本
起止时间：
2006 至 2007
项目状态：
已结题

项目摘要

We have succeeded a living-donor lober lung transplantation (LDLLT) at Okayama University Hospital in 1998, which was the first lung transplantation (LT) in Japan. We performed LT in 57 critically ill patients (47 patients of LDLLT) from 1999 to 2007. Reperfusion lung injury (RLI) occurs following lung transplantation, and is a major post-operative complication. A major cause of the death is RLI and the treatment has not been established in LT. Inflammatory mediators play an important role in the modulation of reperfusion injury. LDLLT is generally performed with the use of cardiopulmonary bypass (CPB). CPB exacerbates inflammatory response in recipient and the reperfusion of grafts after CPB may deteriorate ischemia-reperfusion injury. Modified ultrafiltration (MUF) has been developed as an effective perfusion strategy to minimize the adverse effects of CPB in open heart surgery. MUF may modulate systemic inflammatory mediators and inprove hemoddynamics and graft function after LT. No … More report of the effectiveness of MUF in LT has shown. We measure intraoperative levels of key cytokines and polymorphonuclear elastase (PMN-E) in plasma in patients undergoing LDLLT surgery with CPB. This study analyzed the clinical application of MUF to minimize cardiopulmonary bypass (CPB)-related lung injury in patients undergoing LDLLT.LT patients demonstrated significant elevations of IL-6 and PMN-E during and after CPB. IL-6 production increased significantly after CPB. Ischemic and CPB time did not correlate with IL-6 and PMN-E levels. Our data suggest that production of inflammatory cytokines and mediators are triggered by CPB and that production of IL-6 is accelerated by reperfusion of lung grafts after CPB. MUF did not inhibit the increase of serum IL-6 level, nor decrease IL-8 and PMN-E levels. MUF brought improved hemodynamics and gas exchange capacity of transplanted grafts and lowered post-operative blood loss and blood transfusion requirement. This strategy may minimize CPB-related adverse effects in patients undergoing LDLLT. Less

1998年，我们在冈山大学医院成功进行了活体供体肺叶移植（LDLLT），这是日本第一例肺移植（LT）。从1999年到2007年，我们对57例危重患者进行了肝移植（其中47例为LDLLT）。再灌注肺损伤（RLI）发生在肺移植术后，是主要的术后并发症。死亡的主要原因是再灌注损伤，而lt的治疗尚未确定。炎症介质在再灌注损伤的调节中起重要作用。LDLLT通常与体外循环（CPB）一起进行。CPB可加重受体炎症反应，CPB后移植物再灌注可加重缺血再灌注损伤。改良超滤（MUF）已成为一种有效的灌注策略，以减少体外循环（CPB）在心脏直视手术中的不良反应。MUF可以调节全身炎症介质，改善LT后的血流动力学和移植物功能。更多关于MUF在LT中的有效性的报道已被证实。我们测量了伴有CPB的LDLLT手术患者术中血浆中关键细胞因子和多形核弹性酶（PMN-E）的水平。本研究分析了MUF在LDLLT患者减少体外循环（CPB）相关肺损伤中的临床应用。在CPB期间和之后，LT患者表现出IL-6和PMN-E的显著升高。CPB后IL-6产量显著增加。缺血和CPB时间与IL-6和PMN-E水平无相关性。我们的数据表明，CPB可触发炎症细胞因子和介质的产生，并且CPB后肺移植物的再灌注可加速IL-6的产生。MUF不抑制血清IL-6水平的升高，也不降低IL-8和PMN-E水平。MUF改善了移植移植物的血流动力学和气体交换能力，降低了术后失血量和输血需求。这种策略可以最大限度地减少接受LDLLT患者cpb相关的不良反应。少