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首页> 外文期刊>Journal of Clinical Medicine >Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Blood Electrolytes and Metabolites—A Randomized Controlled Trial
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Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Blood Electrolytes and Metabolites—A Randomized Controlled Trial

机译：心肺旁路手术中的肺保护策略影响血液电解质和代谢产物的组成-一项随机对照试验

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Cardiac surgery with cardiopulmonary bypass (CPB) causes an acute lung ischemia-reperfusion injury, which can develop to pulmonary dysfunction postoperatively. This sub-study of the Pulmonary Protection Trial aimed to elucidate changes in arterial blood gas analyses, inflammatory protein interleukin-6, and metabolites of 90 chronic obstructive pulmonary disease patients following two lung protective regimens of pulmonary artery perfusion with either hypothermic histidine-tryptophan-ketoglutarate (HTK) solution or normothermic oxygenated blood during CPB, compared to the standard CPB with no pulmonary perfusion. Blood was collected at six time points before, during, and up to 20 h post-CPB. Blood gas analysis, enzyme-linked immunosorbent assay, and nuclear magnetic resonance spectroscopy were used, and multivariate and univariate statistical analyses were performed. All patients had decreased gas exchange, augmented inflammation, and metabolite alteration during and after CPB. While no difference was observed between patients receiving oxygenated blood and standard CPB, patients receiving HTK solution had an excess of metabolites involved in energy production and detoxification of reactive oxygen species. Also, patients receiving HTK suffered a transient isotonic hyponatremia that resolved within 20 h post-CPB. Additional studies are needed to further elucidate how to diminish lung ischemia-reperfusion injury during CPB, and thereby, reduce the risk of developing severe postoperative pulmonary dysfunction.
机译：进行心脏体外循环（CPB）的心脏手术会导致急性肺缺血-再灌注损伤，并可能在术后发展为肺功能障碍。这项肺保护试验的子研究旨在阐明90例慢性阻塞性肺疾病患者在采用两种肺保护性肺动脉灌注方案同时使用低温的组氨酸-色氨酸-肺动脉灌注治疗后的动脉血气分析，炎性蛋白白细胞介素-6和代谢产物的变化。与没有肺部灌注的标准CPB相比，CPB期间的酮戊二酸（HTK）溶液或常温含氧血液。在CPB之前，之后和长达20小时的六个时间点采集血液。使用血气分析，酶联免疫吸附测定和核磁共振波谱学，并进行多变量和单变量统计分析。在CPB期间和之后，所有患者的气体交换减少，炎症加剧和代谢产物改变。虽然接受含氧血液的患者和标准CPB患者之间没有差异，但是接受HTK溶液的患者体内代谢产物过多，涉及能量产生和活性氧排毒。另外，接受HTK的患者在CPB后20小时内即可解决短暂性等渗性低钠血症。需要进一步的研究来进一步阐明如何减轻CPB期间的肺缺血-再灌注损伤，从而减少发生严重的术后肺功能障碍的风险。

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