器官移植是许多器官功能障碍最理想的救治方法，但面临的重要挑战是缺乏捐献者。为克服这一问题，对已经发生死亡的器官进行功能保护就是比较重要的问题，器官肺保护可采用体外肺灌流技术进行。考虑到氢是一种理想的生物抗氧化物质，最新研究在体外肺灌流时使用氢气，获得了理想的保护效果，那么这种简单技术有可能对提高器官保护效率有重要应用前景。研究来自韩国首尔延世大学医学院Paik HC小组，Nakao教授也是参与者之一。Nakao教授是氢医学研究先驱，是美国最早发表相关论文的小组负责人，2011年日本发生海啸后，他依然离开工作近10年的美国匹滋堡大学，携带妻儿返回日本兵库医科大学，作为一名灾难和重症医学医生，给自己的同胞提供救助。近年来他从事研究的时间比较少，但也一直有一些合作研究。最新这一研究就是在他最熟悉的器官移植保护方面与韩国进行的合作之一。

不过这种策略，Nakao教授离开后美国匹滋堡大学已经发表过，不过这次的研究动物是用猪。呼吸氢的浓度为2%，这个浓度我个人认为不是一个比较理想的选择，如果人体使用受到燃烧浓度的影响，还可以理解，那么体外保护这种几乎没有任何理由不选择更高浓度作为保护手段。这或许就是科学研究领域的玻璃天花板效应吧。对一些自己不熟悉的内容，不敢进行基本的创新和改进。

Haam S, Lee S, Paik HC, Park MS, Song JH, Lim BJ, Nakao A.the effects of hydrogen gas inhalation during ex vivo lung perfusion on donor lungs obtained after cardiac death† Eur J Cardiothorac Surg. 2015 Mar 6. pii: ezv057. [Epub ahead of print]

The effects of hydrogen gas inhalation during ex vivo lung perfusion on donor lu.pdf

Paik HC：hcpaik@yuhs.ac.

Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan.

OBJECTIVES: Lung transplantation is a well-established treatment of end-stage lung disease; however, it is limited by a shortage of donor lungs. To overcome this problem, donation after cardiac death (DCD) and ex vivo lung perfusion (EVLP) are being widely investigated. In this study, the effect of hydrogen gas, a known antioxidant, was investigated on a DCD lung model during EVLP.

METHODS: Ten pigs were randomized into either a control (n = 5) or a hydrogen group (n = 5). After fibrillation by electric shock, no further treatment was administered in order to induce warm ischaemic injury for 1 h. The lungs were then procured, followed by 4 h of EVLP. During EVLP, the lungs were ventilated with room air in the control group, and with 2% hydrogen gas in the hydrogen group. Oxygen capacity (OC), pulmonary vascular resistance (PVR) and peak airway pressure (PAP) were measured every hour, and the expressions of interleukin-1 beta (IL-1β), IL-6 (IL-6), IL-8 (IL-8) and tumour necrosis factor-alpha (TNF-α) were evaluated in lung tissue after EVLP. Pathological evaluations were performed using lung injury severity (LIS) scores and the wet/dry ratio was also measured.

RESULTS: The OC in the hydrogen group was higher than in the control group, but the difference was not statistically significant (P = 0.0862). PVR (P = 0.0111) and PAP (P = 0.0189) were statistically significantly lower in the hydrogen group. Compared with the control group, the hydrogen group had a statistically significantly lower expression of IL-1β (P = 0.0317), IL-6 (P = 0.0159), IL-8 (P = 0.0195) and TNF-α (P = 0.0159). The LIS scores (P = 0.0358) and wet/dry ratios (P = 0.040) were also significantly lower in the hydrogen group.

CONCLUSIONS: Hydrogen gas inhalation during EVLP improved the function of DCD lungs, which may increase the utilization of DCD lungs.

© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.