Influence of pulmonary artery perfusion with solution of washed red blood cells on lung injury after cardiopulmonary bypass

Abstract

To observe the influence of intra-operative pulmonary artery perfusion with hypothermic washed red blood cell (RBC) solution on lung injury after cardiopulmonary bypass (CPB). Thirty patients of mitral disease with pulmonary hypertension undergoing mitral valve replacement were randomly divided into 2 equal groups: control group, and perfusion group (with the pulmonary artery infused with 4 degrees C washed RBC protective solution during CPB). The blood cell count, pulmonary vascular resistance (PVR), white blood cell (WBC) ratio (venous blood/arterial blood), plasma malonyldialdehyde (MDA), and oxygenation index (OI), were measured and the time of mechanical ventilation was obtained as well. (1) The PVR at the end of CPB, and 12 h and 24 h after CPB of the perfusion group were 46.4 kPa.s.L(-1) +/- 8.1 kPa.s.L(-1), 48.5 kPa.s.L(-1) +/- 7.0 kPa.s.L(-1), and 36.1 kPa.s.L(-1) +/- 6.3 kPa.s.L(-1) respectively, all significantly lower than those of the control group (65.7 kPa.s.L(-1) +/- 5.3 kPa.s.L(-1), 79.8 kPa.s.L(-1) +/- 8.7 kPa.s.L(-1), and 47.9 kPa.s.L(-1) +/- 7.1 kPa.s.L(-1) respectively, all P < 0.05). (2) The levels of MDA at the end of CPB, and 12 h and 24 h after CPB of the perfusion group were 14.3 mmol/L +/- 0.8 mmol/L, 16.1 mmol/L +/- 0.7 mmol/L, and 13.3 mmol/L +/- 0.5 mmol/L respectively, all significantly lower than those of the control group (18.9 mmol/L +/- 0.9 mmol/L, 21.6 mmol/L +/- 0.4 mmol/L, and 22.5 mmol/L +/- 0.7 mmol/L respectively, all P < 0.05). (3) The WBC ratios of vein and artery (V/A) a the end of CPB and 12 h after CPB of the perfusion group were 1.16 +/- 0.05 and 1.20 +/- 0.05 respectively, both significantly lower than those of the control group (1.53 +/- 0.07 and 1.68 +/- 0.25 respectively (both P < 0.01). (4) The OI at the end of CPB, and 12 h and 24 h after CPB of the perfusion group were 370 +/- 33, 388 +/- 41, and 414 +/- 39 respectively, all significantly higher than those of the control group (217 +/- 30, 210 +/- 36, and 222 +/- 33 respectively (all P < 0.05). (5) The time of mechanical ventilation the perfusion group was 13 h +/- 4 h, significantly shorter than that of the control group (27 h +/- 6 h, P < 0.01). Pulmonary artery perfusion with hypothermic washed RBC protective solution alleviates the lung injury after cardiopulmonary bypass.