Experimental Study on Microthrombi Formation for Lung Transplantation from Non-Heart-Beating Donor

背景资料：我们以前曾报道过，死后通过闭胸心脏按摩进行肝素化对无心跳供体的肺移植是有益的，可以防止微血栓的形成。在这项研究中，我们评估了最佳的时间死后肝素化犬肺移植从无心跳的供体。方法：对37只体重匹配的杂种犬进行左肺移植。通过静脉注射氯化钾处死供体，并在室温下放置2小时。根据死后肝素化的时间将尸体供体随机分配到5个组中的一个。肝素钠1, 000 U/kg静注后，心脏按压2分钟。心脏停搏2小时后，用低钾右旋糖酐葡萄糖溶液冲洗供体肺并保存60分钟。左肺同种异体移植后，结扎右肺动脉，并对受体动物进行3小时的随访。我们还给予240，000单位的尿激酶60分钟后心脏停搏肝素化。结果：移植后，气体交换显着恶化时，热缺血时间超过30分钟。尿激酶的管理显着改善肺function.Conclusions：死后肝素化在肺移植从非心脏跳动供体的最佳时间是在心脏骤停后30分钟附近。尿激酶沿着肝素的死后给药通过对尸体供体肺中已经形成的肺微血栓的纤维蛋白溶解作用而有益于无心跳供体的肺移植。

Background: We previously reported that postmortem heparinization by closed-chest cardiac massage is beneficial in lung transplantation from non-heart-beating donors by preventing microthrombi formation. In this study, we evaluated the optimal time for postmortem heparinization in canine lung transplantation from non-heart-beating donors. We also evaluated the effects of most-mortem administration of urokinase.Methods: Left lung transplantation was performed in 37 weight-matched pairs of mongrel dogs. Donors were sacrificed with an intravenous injection of potassium chloride and left at room temperature for 2 hours. The cadaver donors were assigned randomly to one of the 5 groups according to the timing of post-mortem heparinization. Heparin sodium (1,000U/kg) was given intravenously followed by closed-chest cardiac massage for 2 minutes. After 2 hours of cardiac arrest, donor lungs were flushed with low potassium dextran glucose solution and preserved for 60 minutes. Following left lung allotransplantation, the right pulmonary artery was ligated, and recipient animals were followed up for 3 hours. We also gave 240,000 Unit of urokinase after 60 min of cardiac arrest following heparinization.Results: After transplantation, gas exchange was significantly worse when warm ischemic time exceeded 30 minutes. Administration of urokinase significantly improved pulmonary function.Conclusions: The optimal time for postmortem heparinization in lung transplantation from non-heart beating donors is in the vicinity of 30 minutes after cardiac arrest. Postmortem administration of urokinase along with heparin is beneficial in lung transplantation from non-heart-beating donors by fibrinolytic action on already formed pulmonary microthrombi in the cadaver donor lungs.