Effects of polymyxin B-immobilized fibers in normothermic cardiopulmonary bypass.

（实验1）目的：探讨多粘菌素b -固定化纤维（PMX）直接血液灌流对猪常温心脏手术的影响。方法：将10对猪分为2组。动物麻醉后，按常规方式建立恒温CPB。对照组动物采用恒温CPB回路灌注。PMX组动物采用含有多粘菌素b -浸染纤维的内毒素去除柱灌注，以80ml/min的流速从CPB引入至实验结束。间歇顺行温血停搏获得心脏骤停。主动脉交叉夹持时间34 min。分别于CPB前和CPB断奶后2hr测定各组大鼠最大心室弹性（Emax）、心输出量（CO）、左心室压（LVP）、LVP最大增减率（LV dP/dt）和动脉血气。心功能恢复率以百分数表示。结果：PMX组Emax、LVP、CO、-LV dP/dt、PaO_2均明显优于对照组。PMX组心肌组织病理损伤较对照组轻。结论：常温CPB条件下多粘菌素b固定化纤维直接血液灌流可改善心肺缺血再灌注损伤。（实验2）目的：在之前的研究中，我们报道了抑制促炎细胞因子，如肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)，可以改善移植后的结果。在这项研究中，我们评估了使用我们的设备进行持续冠状动脉灌注的长期保存，并结合抑制促炎细胞因子，是否可以改善移植后供者的心脏功能。方法：采用成年杂种犬。心脏骤停后用威斯康星大学溶液冲洗冠状血管床。然后切除心脏，用保存装置浸泡和冠状动脉灌注相结合保存12小时。将成年杂种狗分为冠状动脉灌注（CP）组和FR167653 （FR-CP）组。CP组采用4℃UW溶液浸泡和冠脉灌注。FR-CP组采用4℃UW溶液，加入20 mg/L抗炎剂FR167653浸泡和冠脉灌注。在原位移植后2和3小时，将血流动力学参数与供体动物术前值进行比较。比较两组冠状动脉窦血TNF-α水平及电镜观察。结果：移植后3 h， FR-CP组心输出量（CO）、左心室压（LVP）、左室dp/dt均显著高于CP组。电镜研究表明，与CP组相比，FR-CP组的糖原保存较好。FR-CP组血清TNF-α水平明显低于CP组。结论：FR-CP组移植后血流动力学明显优于CP组。使用我们的设备，结合抑制促炎细胞因子的连续融合和浸泡的联合保存方法可改善移植后供体心脏功能。少

(Experiment 1)Purpose : The purpose of this study was to investigate the effects of direct hemoperfusion using polymyxin B-immobilized fiber (PMX) on normothermic cardiac surgery in pigs. Methods : Ten pairs of pigs were divided into two groups. After anesthesia of animals, Normothermic CPB was established in a usual fashion. Control group animals were perfused using a normothermic CPB circuit. PMX group animals were perfused using an endotoxin removal column containing polymyxin B-imrhobilized fiber, which was introduced at a flow rate of 80ml/min from CPB to the end of experiment. Cardiac arrest was obtained by intermittent antegrade warm blood cardioplegia. Aortic cross clamping time was 34 min. Maximal ventricular elastance (Emax), cardiac output(CO), left ventricular pressure(LVP), the maximum rate of increase and decrease of LVP (LV dP/dt), and arterial blood gas were measured at pre-CPB and 2hr after weaning from CPB. Cardiac functional recovery rates were expressed as a percent … More age of pre-CPB values. Results : Emax,LVP,CO,-LV dP/dt and PaO_2 were significantly better in the PMX group than in the control group. Histopathological tissue damage of the myocardium was milder in the PMX group than in the control group. Conclusion : Direct hemoperfusion using polymyxin B-immobilized fiber in the condition of normothermic CPB ameliorates ischemia-reperfusion injury of the heart and lung.(Experiment 2)Purpose : In a previous study, we reported that suppression of proinflammatory cytokines, such as tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β), improved results after transplantation. In this study, we evaluated whether long-term preservation using our apparatus for continuous coronary perfusion, combined with suppression of proinflammatory cytokines, improves donor heart function following transplantation. Methods : Adult mongrel dogs were used. Coronary vascular beds were washed out with University of Wisconsin(UW) solution following cardiac arrest obtained. The heart was then excised and preserved for 12 h with a combination of immersion and coronary perfusion using a preservation apparatus. Adult mongrel dogs were divided into two groups : the coronary perfusion(CP) group and the FR167653 (FR-CP) group. In the CP group, a 4℃ UW solution was used for both immersion and coronary perfusion. In the FR-CP group, a 4℃ UW solution supplemented with 20 mg/L of the anti-inflammatory agent FR167653 was used for both immersion and coronary perfusion. At 2 and 3 h after orthotopic transplantation, hemodynamic parameters were compared with preoperative values of donor animals. Serum levels of TNF-αin blood from the coronary sinus and electron microscopic studies were compared between the two groups. Results : Three hours after transplantation, cardiac output(CO), left ventricular pressure(LVP) and-LV dp/dt were significantly higher in the FR-CP group than in the CP group. Electron microscopic studies showed that glycogen was well preserved in the FR-CP group as compared with the CP group. Serum levels of TNF-α were significantly reduced in the FR-CP group relative to the CP group. Conclusion : Hemodynamics following transplantation was significantly better in the FR-CP group than in the CP group. The combined preservation method of continuous per fusion and immersion using our apparatus in conjunction with suppression of proinflammatory cytokines improves donor heart function following transplantation. Less