Lung Protection By Pulmonary Artery Perfusion With Cold Oxygenated Blood Containing Adenosine During Cardiopulmonary Bypass

Objective:To evaluate the protective effect of perfusion of pulmonary artery using cold oxygenated blood containing adenosine on the ischemia-reperfusion injury of lung during cardiopulmonary bypass.Methods:30 patients undergoing heart valve replacement complicated with pulmonary hypotension with cardiopulmonary bypass were randomly divided into control group (n=15, infused with 4 ℃ oxygenated blood) and adenosine group (n=15, infused with 4 ℃ oxygenated blood containing adenosine) .Plasma level of TNF-α,IL-6,MDA and the V/A (vein/artery) ratio of WBC were measured before CPB and at 15 minute after aortic cross-clamp, 15 minute after aortic cross-clamp release ,12 hour after operations and 24 hour after operations.Results: 1.The time of mechanical ventilation was significantly shorter in adenosine group than that in control group ((18.60±4.75)h vs(26.40±6.32)h, P<0.05).2.To both control group and adenosine group, the WBC V/A ratio, the levels of IL-6,TNF-α and MDA all increased significantly after CPB; the increase of WBC V/A ratio lasts to 12 hour after operations, the increase of the levels of IL-6 and MDA lasts to 24 hour after operations, and both peaked at 15 minute after aortic cross-clamp release, the increase of the levels of TNF-αlasts to 12 hour after operations, and also peaked at 15 minute after aortic cross-clamp release.3.Compared with the control group,the WBC V/A ratio, as well as the levels of IL-6 and TNF-α of adenosine group were significantly lower at 15 minute after aortic cross-clamp, 15 minute after aortic cross-clamp release and 12 hour after operations (P<0.05).And the levels of MDA were obviously lower at 15 minute after aortic cross-clamp release ,12 hour after operations and 24 hour after operations(P<0.05).Conclusion: 1.Adenosine could reduce the post-CPB lung injury.2.Perfusion with cold oxygenated blood containing adenosine to pulmonary artery could more effectively reduce the ischemia-reperfusion injury of lung and improve the lung function than that with cold oxygenated blood only during CPB. Significance:We studied the protective effect of perfusion of pulmonary artery using cold oxygenated blood containing adenosine on the ischemia-reperfusion injury of lung during cardiopulmonary bypass.,and the result showed that perfusion of pulmonary artery using cold oxygenated blood containing adenosine could more effectively reduce the ischemia-reperfusion injury of lung than that only with cold oxygenated blood during CPB.The study provides to us a new way to reduce the lung injury caused by CPB.