Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. | Apostolakis et al. Journal of Cardiothoracic Surgery 2010 5 1 http content 5 1 1 REVIEW JOTS JOURNAL OF CARDIOTHORACIC SURGERY Open Access Strategies to prevent intraoperative lung injury during cardiopulmonary bypass Efstratios E Apostolakis1 Efstratios N Koletsis1 Nikolaos G Baikoussis1 2 Stavros N Siminelakis2 Georgios S Papadopoulos3 Abstract During open heart surgery the influence of a series of factors such as cardiopulmonary bypass CPB hypothermia operation and anaesthesia as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB reducing its time or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB beneficial effects on lung function are reported. In addition replacement of circuit surface with biocompatible surfaces like heparin-coated and material-independent sources of blood activation a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin which protect the lungs during CPB and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way reducing the use of cardiotomy suction device as well as the contact-time between free blood and pericardium it is
