Lung Protection Of The Leukocyte-depleted Protective Solution During Cardiopulmonary Bypass

Objective: To discuss the effects of lung protection by perfusing the leukocyte-depleted hypothermic protective solution to the pulmonary artery during cardiopulmonary bypass.Methods: Thirty cases undergoing mitral valve replacement (MVR) were divided into three groups at randomly: control group (A, n=10),conventional lung protective group (B, n=10) and leukocyte-depleted lung protective group (C, n=10). Leukocyte-depleted hypothermic protective solution was infused into the main pulmonary artery in group C; hypothermic protective solution was infused into the main pulmonary artery in group B, and nothing was infused into the main pulmonary artery in group A.Patients'lung functions(including respiratory index and oxygenation index at 0h, 6h, 12h and 24h after CPB) and some clinical indexes(including time for aortery clamp, CPB, intubation, ICU-staying and hospitalization,the variations of mean pulmonary arterial pressure, airway resistance, static compliance of lung before and after operation, and having postoperative complications or not)were monitored.Concentrations of plasma malondialdehyde (MDA), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) were measured at 0h, 6h, 12h and 24h after CPB.Results: The time for intubation in group C was significantly less than that in group A(p<0.01), which was also showed between group B and A(p<0.05).However, there was no significiant difference between group B and C(p>0.05). The respiratory index at 0h, 6h, 12h and 24h after CPB were significiantly lower in group C than that in group A(p<0.05 or 0.01), which were also showed between group B and A(p<0.05 or 0.01), but there was no significiant differences between group B and C(p>0.05).The oxygenation index at 0h, 6h, 12h and 24h after CPB in group C were significiantly higher than that in group A(p<0.05 or 0.01), which were also showed between group B and A(p<0.05 or 0.01).However, there were no significiant differences between group B and C(p>0.05).The variations of mean pulmonary arterial pressure, airway resistance, static compliance of lung before and after operation were statistical significance between group C and A(p<0.05 or 0.01),which were also showed between group B and A(p<0.05 or 0.01), but there were no significiant differences between group B and C(p>0.05).The concentrations of plasma malondialdehyde (MDA), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) at 0h, 6h, 12h and 24h after CPB measured in group C were significantly lower than that in group A(p<0.05 or 0.01),which were also showed between group B and A(p<0.05 or 0.01). However, there were no significiant differences between group B and C(p>0.05). There were no significiant changes for the time of ICU-staying and hospitalization in three groups(p>0.05).Conclusions: Leukocyte-depleted hypothermic protective solution perfused through pulmonary artery can significantly inhibit the increasing of MDA, IL-6 and TNF-αlevels in plasma,reduce the respiratory index, improve the oxygenation index and CLS, anesis the up of PAP and AR, short the time for intubation after CPB, which reduce the injury of lung significiantly and demonstrating the effects of lung protection.However, compared with the group which perfused hypothermic protective solution to pulmonary artery during CPB, the effects of lung protection could not be better.