肺再灌注损伤lung reperfusion injury after transplantation

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1、LungReperfusionInjuryAfterTransplantationReferencesIschemia-Reperfusion-inducedLungInjuryAmJRespirCritCareMed,2003ReducedNeutrophilInfiltrationProtectsAgainstLungReperfusionInjuryAfterTransplantationAnnThoracSurg1999ContentsIntroductionDonorlungassessmentEffec

2、tofcoldischemicstorageOxidativestressSodiumpumpinactivationIntracellularcalciumoverloadIronreleaseCelldeathConsequencesofischemia&reperfusionUpregulationofmoleculesoncellsurfacemembraneReleaseofproinflammatorymediatorsLeukocyteactivationStrategiestopreventlung

3、dysfunctionMethodoflungpreservationandreperfusionClinicalevidenceinpreventionandtreatmentoflungreperfusioninjuryFutureStrategiesTakehomemessageIntroductionNon-specificalveolardamage,lungedema,andhypoxemiaoccurringwithin72hoursafterlungtransplantationRemainsasi

4、gnificantcauseofmorbidityandmortalityafterlungtransplantationDonorLungAssessmentParameters:donorhx,ABG,CXR,bronchoscopyfindings,PEofthelungStrictcontraindications：bil.infiltratesonCXR,persistentpusatbronchoscopy,signsofbronchaspirationBrainstemdeath:upregulate

5、dIL-8;significantlycorrelatew/primarygraftfailureafterreperfusionDonorLungAssessmentDonorLungAssessmentEffectofColdIschemicStorageOxidativestressSodiumpumpinactivationIntracellularcalciumoverloadIronreleaseCelldeathOxidativeStressFormationofROS:superoxideanion

6、、hydrogenperoxide、hydroxylradicalCellinjuryproducedbylipidperoxidationIschemia-reperfusion≒anoxia-reoxygenationinmostorgantransplantationLungtobeconsidereddifferentlyEndothelium:oneofthepredominantsourcesofoxidantsduringnon–hypoxiclungischemiaOxidativeStressSo

7、diumPumpInactivationSodium(Na/K-ATPase)pump:importanttopreserveproperintracellularelectrolyteconc.andtomaintainadequateclearanceofalveolarfluidHypothermicstorageresultsinlossoffunction,thencellswellingPreservationat10℃superiorthanat4℃Resumebetterifpreservedw/e

8、xtracellular-typepreservationsolution(lowK,highNa)IntracellularCalciumOverloadHypothermicstoragealterscalciummetabolismbyreleaseofcalciumfromintracellulardepotsandbypathologicinflu