Clinical Studies Of Pulmonary Perfusion With Hypothermic Htk Solution On The Immature Lung During Cardiopulmonary Bypass Injury

SECTION 1:Lung perfusion with HTK solution relieves lung injury in corrections of Tetralogy of Fallot.Objective To evaluate the protective effect of pulmonary perfusion with hypothermic HTK solution on lung function after cardiopulmonary bypass (CPB) in corrections of Tetralogy of Fallot.Methods Between January 2009 and June 2009,24 consecutive infants with Tetralogy of Fallot were randomly divided into perfusion group (n=12), which underwent pulmonary perfusion with hypothermic HTK solution, and control group (n=12). Oxygen index (O(?)), alveolar-arterial O2 gradient (AaDO2), serum levels of malondialchehyche (MDA), interleukin 6,8,10 (IL-6,8,10), tumor necrosis factor-α(TNF-α), endothelin-1 (ET-1), soluble intercellular adhesion molecule-1 (sICAM-1), and P-selectin were measured before commencement and serially for 48 hours after termination of bypass.Results Oxygenation values were better preserved in the perfusion group than in the control group. The serum levels of IL-6 and IL-8 rose immediately after CPB in both groups and remained at high level at 48h after CPB in control group. But in perfusion group, IL-6 levels returned to baseline at 48h after CPB and IL-8 restored baseline level at 12,24,48h after CPB. The serum levels of IL-10 rose immediately after CPB and decreased to normal at 24h after CPB in both groups. The serum levels of TNF-αsICAM-1 and MDA kept baseline at each time point after CPB in perfusion group and elevated significantly immediately after CPB in control group, but TNF-αand MDA dropped to baseline at 12h after CPB and sICAM-1 accessed to baseline until 48h after CPB. The serum P-selectin and ET-1 kept pre-CPB level immediately after CPB in both groups. However P-selectin levels rose significantly in control group and decreased significantly in perfusion group at 12h after CPB. ET-1 levels rose significantly at 12h after CPB in both groups and were still higher than baseline at 48h after CPB. Moreover, the intubated time, ICU time and hospital charges were lower in perfusion group than control group, and the differences are significant. Conclusions This study suggests that in infants having Tetralogy of Fallot, pulmonary perfusion with hypothermic HTK solution during cardiopulmonary bypass relieves lung injury and promote clinical outcome. 北京协和医学院博士研究生毕业论文肺动脉灌注低温HTK液对未成熟肺体外循环损伤作用的临床研究SECTION 2:Lung perfusion with HTK solution reduces lung injury of infants with pulmonary hypertension after cardiopulmonary bypass.Objective To evaluate the protective effect of pulmonary perfusion with hypothermic HTK solution on lung function and inflammatory reaction after cardiopulmonary bypass (CPB) in corrections of congenital heart defects with moderate-severe pulmonary hypertension.Methods Between June 2009 and December 2009,24 consecutive infants with congenital heart defects and moderate-severe pulmonary hypertension were randomly divided into perfusion group (n=12), which underwent pulmonary perfusion with hypothermic HTK solution, and control group (n=12). Oxygen index (OI), alveolar-arterial O2 gradient (AaDO2), serum levels of malondialchehyche (MDA), interleukin 6,8,10 (IL-6,8,10), tumor necrosis factor-α(TNF-α), endothelin-1 (ET-1), soluble intercellular adhesion molecule-1 (sICAM-1), and P-selectin were measured before commencement and serially for 48 hours after termination of bypass.Results Oxygenation values were better preserved in the perfusion group than in the control group. The serum levels of IL-6 rose immediately after CPB in both groups and returned to baseline at 48h after CPB, but it restored more faster and earlier in perfusion group, and differences of IL-6 levels at 12,24h after CPB between groups are significant. The serum levels of IL-8, TNF-α, sICAM-1, MDA kept baseline at each time point after CPB in perfusion group and elevated significantly immediately after CPB in control group, except for sICAM-1 levels which elevated until 12h after CPB. Afterward, the IL-8, TNF-αlevels returned to baseline at 12h after CPB and MDA levels decreased gradually and restored baseline level at 48h after CPB. The serum levels of IL-10 rose immediately after CPB and decreased to normal at 48h after CPB in both groups, but at 12h after CPB the IL-10 levels in perfusion group were significantly higher than in control group. The serum P-selectin levels in control group were significantly higher than pre-CPB level only at 0h after CPB, and in perfusion group the P-selectin levels never rose, and even decreased slightly at 24,48h after CPB. ET-1 levels rose significantly at 12h after CPB in both groups and were still higher than baseline at 48h after CPB. There are not any significant differences in ET-1 levels between groups. Moreover, there are no significant differences in postoperative clinical characters, except for the intubated time.Conclusions This study suggests that in infants having congenital heart defects, pulmonary perfusion with hypothermic HTK solution during cardiopulmonary bypass could ameliorate lung function and reduce inflammatory reaction.