低温肺保护液改善体外循环对肺内中性白细胞凋亡的抑制作用

Hypothermic protective solution attenuates cardiopulmonary bypass induced the inhibition of intrapulmonary neutrophils apoptosis in children with severe pulmonary hypertension

目的 体外循环通过抑制体内中性白细胞凋亡 ,延长炎症反应时间。通过观察保护液低温肺灌注对合并重度肺高压患儿体外循环后肺内中性白细胞凋亡的诱导 ,评价低温肺保护液促进术后炎症的消散作用。方法 34例重度肺动脉高压先心病患儿分为对照组 ( 2 3例 )和肺保护组 ( 11例 )。对照组行常规手术矫治心内畸形 ,保护组于心脏阻断后向肺动脉灌注低温肺保护液 ,此后亦行常规手术完成心内畸形的矫治。手术后留右下肺组织行原位末端标记技术检测肺内中性白细胞凋亡情况。结果 对照组肺内中性白细胞凋亡率为 13 8% ;保护组凋亡率达 5 3 4 %。结论 低温保护液可以改善体外循环对肺内中性白细胞凋亡的抑制作用 ,促进炎症消散 。

Objective Cardiopulmonary bypass(CPB)could inhibit the apoptosis of the intrapulmonary neutrophils and prolonged the inflammatory response in the lung tissue This study examined the expression of intrapulmonary neutrophils apoptosis in children with severe pulmonary hypertension using the technique of pulmonary artery perfusion with hypothermic solution after CPB, and evaluate its effect on resolution of neutrophil mediated inflammation in the lung Methods 34 young children with congenital heart disease and severe pulmonary hypertension were divided into the control group ( n =23) and the protective group ( n =11) The basic parameters (age, weight, data of catheterization and other assistant examination) were not different between two groups The patients in the control group were performed using routine techniques, and in the protective group patients′ pulmonary artery were infused with 4℃ protective solution during CPB Patients′ lung biopsies were made for neutrophils apoptosis measure by ISEL(in situ end labeling) techniques The sections were dewaxed and washed, fixed tissue section with 4% paraformaldehyde solution, added TUNEL( TdT mediated dUTP nick end labeling) reaction mixture on sample, anti Dig Ap and NBT+BCIP was added to show color, then sections were counterstained with methyl green There are ten sections were observed in each group and one hundred neutrophils were counted in every section The results were demonstrated by the percentage of positive neutrophil number Results There are 13 8% neutrophils apoptosis in the control lungs, whereas in the protective group, the rate of apoptotic neutrophils was 53 4% Conclusion The hypothermic solution could attenuate CPB induced the inhibition of intrapulmonary neutrophils apoptosis with pulmonary hypertension, accelerate the resolution of the neutrophils mediated inflammation, and protect the pulmonary function after CPB