氧自由基清除剂对缺血犬心肌再灌注损伤的保护作用

杂种犬１４只，平均体重１３．７ｋｇ，随机分为３组，Ａ－对照组（ｎ＝４），Ｂ－超氧化物歧化酶组（ＳＯＤ）（ｎ＝５），Ｃ－辅酶Ｑ（１０）组（ＣｏＱ１０）（ｎ＝５），Ｂ、Ｃ组在４℃高钾心肌保护液中分别加入ＳＯＤ（６万Ｕ／１００ｍｌ），ＣｏＱ１０（８ｍｇ／１００ｍｌ），在深低温停循环体外循环手术动物模型基础上，观察心肌组织氧自由基产生量、三磷酸腺苷（ＡＴＰ）含量、冠脉血肌酸磷酸激酶（ＣＰＫ）浓度的变化以及心肌超微结构。发现在停循环再灌注１０ｍｉｎ时，Ｂ、Ｃ组氧自由基产生量、ＣＰＫ浓度升高幅度明显低于Ａ组，ＡＴＰ含量下降幅度明显低于Ａ组；在再灌注３０ｍｉｎ，Ｃ组ＡＴＰ含量有回升趋势。再灌注３０ｍｉｎ时心肌超微结构可见Ｂ、Ｃ组心肌损伤较Ａ组轻，Ｃ组心肌损伤减轻略明显。结论：（１）心肌缺血再灌注后，再灌注早期损伤尤甚，氧自由基是造成这种损伤的病理基础；（２）ＣｏＱ１０、ＳＯＤ都具有清除氧自由基、减轻损伤、保护心肌作用；（３）ＣｏＱ１０对损伤的心肌细胞能源代谢的恢复有益。     

不同缺血方式对肾脏组织ATP水平的影响

目的 研究不同缺血方式对大鼠肾脏组织中三磷酸腺苷（ＡＴＰ）水平的影响。方法 将大鼠分为４组，假手术组（Ａ组）；持续缺血组（Ｂ组）；间断缺血组（Ｃ组）’缺血预处理组（Ｄ组）。利用生物化学发光法测量不同缺血－再灌注处理后大鼠肾组织ＡＴＰ水平的变化。结果 各缺血组大鼠肾脏在缺血终末期时ＡＴＰ水平明显下降，仅为正常对照组的１０％左右。再灌注３０ｍｉｎ后，Ｃ组肾组织ＡＴＰ水平恢复到正常水平的６０％左右。而Ｂ     

常温体外循环下常温充氧晶体和氧合血停搏液持续灌注的心肌…

对比研究常温体外循环下常温充氧晶体和氧合血停搏液持续灌注对阻断升主动脉后犬心肌的保护效果，１５只犬随机分三组，每组５只，即低温体外循环冷搏液间断灌注组；常温体外循环常温氧合血停搏液持续灌注组；常温体外循环常温充氧晶掏搏液持续灌注组。观察了阻断升主动脉前心肌超微结构，腺苷酸含量（ＡＴＰ、ＡＤＰ、ＡＭＰ）、脂质过氧化物、水含量及血流动力学的变化。结果显示，温血组和温晶组在阻断升主动脉１５分钟、５０分钟     

深低温停循环下的脑保护方法

将１０只犬随机分为对照组（Ａ组）与脑保护液组（Ｂ组），经体外循环降温至１８℃并停止全身循环２小时。Ｂ组于停循环即刻通过颈总动脉向头部灌注４℃充氧不含钾晶体液（５０ｍｌ／ｋｇ），随后每３０分钟再灌注一次（１０ｍｌ／ｋｇ），至停循环末，复温至３７℃，继续观察６小时。Ａ组处理同Ｂ组但不灌注脑保护液。分别于五个时相取脑皮层测三磷酸腺苷（ＡＴＰ）与丙二醛（ＭＤＡ），并进行超微结构观察，动态记录脑电图。结果表     

心脏瓣膜置换术中防治心肌缺血／再灌注损伤的临床研究

在２７例心脏瓣膜置换术中观察了充氧停跳液和异搏定停跳液防治心肌缺血／再灌注损伤的效果，并以钾停跳液作为对照。分别在缺血前、再灌注前和再灌注后不同时期测定血清心肌酶（ＬＤＨ、ＣＰＫ、ＧＯＴ），心肌丙二醛（ＭＤＡ），观察心肌超微结构变化，并作线粒体比表面测定。结果显示充氧组和异搏定组再灌注后心肌酶释放量和心肌ＭＤＡ含量均明显低于对照组。心肌超微结构损伤轻，线粒体比表面无明显减小。提示充氧或异搏定钾停跳液能提供良好的心肌保护效果，减轻心肌再灌注损伤。     

利多氟嗪加强间断缺血心停搏心肌保护作用的实验研究

报道常温下用利多氟嗪（ｌｉｄｏｆｌａｚｉｎｅ）预处理加强间断主动脉阻断心停搏心肌保护作用的实验研究。１６只犬随机分为对照组和实验组。结果发现，实验组心脏血流动力学的恢复要明显优于对照组。二组间心肌组织ＡＴＰ、腺苷和肌苷以及冠脉回流液中ＣＰＫ、ＣＰＫＭＢ、ＬＤＨ、ＳＯＤ和ＭＤＡ值均有显著性差异（Ｐ＜０．０１）。结论：冠脉搭桥术中采用间断缺血心停搏时加用利多氟嗪有利于保存心肌能量，减轻心肌再灌注损伤和术后迅即恢复心脏功能     

失血性休克中丹参和超氧化物歧化酶抑制脂质过氧化反应的研究

观察了复方丹参液及ＳＯＤ对失血性休克家免再灌注血液及组织（肝、肠）脂质过氧化反应的影响。结果表明，丹参及ＳＯＤ均能有效降低休克再灌注动物血液脂质过氧化反应程度，丹参降低组织（肠）脂质过氧反应作用优于ＳＯＤ。本实验将１８只失血性休克家兔随机分为三组。休克９０分后，回输放血总量的１／３血液，同时各组动物分别输注平衡盐液（Ａ组）、含ＳＯＤ平衡盐液（Ｂ组）及含复方丹参液平衡盐液（Ｃ组）。Ａ组再灌注后血清ＭＤＡ显著增加，ＭＡＰ逐渐下降，组织（肠、肝）ＭＤＡ含量较高。而Ｂ组及Ｃ组再灌注后血清ＭＤＡ迅速下降，于再灌注３小时恢复至休克前水平，并显著低于Ａ组，且ＭＡＰ进行性升高，于再灌注第３小时显著高于Ａ组。再灌注３小时时Ｃ组肠组织ＭＤＡ含量显著低于Ａ组（Ｐ＜０．０１）及Ｂ组（Ｐ＜０．０５），而肝组织ＭＤＡ含量各组无显著差别。丹参降低组织（肠）脂质过氧化反应作用优于ＳＯＤ，可能与丹参分子量小、容易透过细胞膜以及丹参的组织分布较快等有关。     

卡托普利对心肌组织高能磷酸化合物代谢的影响

观察含卡托普利（巯甲丙脯酸）的停搏液及再灌注血液对心肌组织高能磷酸化合物代谢的影响。用杂种犬１６条，随机分为对照组（Ｓｔ．Ｔｈｏｍａｓ改型停搏液）、卡托普利（ｃｐｌ）组（含ｃｐｌ４．６μｍｏｌ／Ｌ的Ｓｔ．Ｔｈｏｍａｓ停搏液改型及再灌注血液）。测定心肌组织三磷酸腺苷（ＡＴＰ）、二磷酸腺苷（ＡＤＰ）、一磷酸腺苷（ＡＭＰ）、肌酸肌苷（ＣＰ）、丙二醛（ＭＤＡ）含量、股动脉及冠状静脉窦血气及乳酸值，计算心肌氧摄取率。结果表明，心脏复跳后ｃｐｌ组ＡＴＰ、ＡＤＰ、ＡＭＰ及ＣＰ的恢复率、心肌氧摄取率均明显高于对照组，而心肌组织ＭＤＡ含量、冠状静脉窦与股动脉的血乳酸含量差值明显低于对照组。提示含４．６μｍｏｌ／Ｌｃｐｌ的停搏液及再灌注血液可改善心肌组织氧的供需平衡，增加心肌组织氧摄取率及乳酸利用率，增加ＡＴＰ的合成，从而改善心肌缺血再灌注后心肌组织的能量代谢及心功能     

心内直视手术中去白细胞血灌注液对心肌的保护作用

目的 评价心内直视手术期间使用滤除白细胞的血液灌注液对心肌的保护效果。方法 ３０例择期行心脏瓣膜替换术的患者，ＡＳＡⅡ～Ⅳ级，均采用芬太尼－安氟醚复合麻醉，以４℃高钾晶体液灌注停跳，据第二次灌注液成份不同随机分为３组，每组１０例；晶体 组（ＣＳ）、全血组（ＷＢ）和去白细胞血（ＬＤ）组，于肝素化前，ＣＰＢ开始５ｍｉｎ，主动脉开放前５ｍｉｎ，开放后３０ｍｉｎ、１ｈ、２ｈ、２４ｈ采取外周动脉血测定ＣＫ－ＭＢ、ＩＬ－８、ＴＮＦα浓度，于主动脉阻断前、开放前、开放后１５ｍｉｎ取右心房心肌标本，测定心肌含水量和心肌组织Ｃａ＾２＋含量和心肌组织Ｃａ＾２＋含量，观察心肌组织超微结构改变，对心肌线粒体变化进行半定量评价。结果 开放主动脉后，每组ＣＫ－ＭＢ、ＩＬ－８水平较开放前明显升高，开放后２ｈ升高更明显（Ｐ〈０．０５），但ＬＤ     

7.5%高渗氯化钠溶液复苏失血性休克对红细胞能量代谢的影响

目的：观察小剂量高渗氯化钠（ＨＳ）复苏失血性休克时红细胞（ＲＢＣ）能量代谢的变化。方法：２０只健康家兔被随机分为三组，（甲组）正常血容量输注ＨＳ组；（乙组）休克输注ＮＳ复苏组；（丙组）休克输注ＨＳ复苏组。以ＲＢＣ内ＡＴＰ和２，３－ＤＰＧ水平作为ＲＢＣ能量代谢的指标。结果：休克后ＲＢＣ内ＡＴＰ和２，３－ＤＰＧ水平显著下降，应用小剂量ＨＳ复苏后两项指标均有所回升，在输注后１２０分钟有显著增高。结论：应用小剂量ＨＳ可使失血性休克后的ＲＢＣ能量代谢状态发生明显改善，这可能是促进ＨＳ有效复苏休克的重要因素。     

不同深低温停循环方法对脑组织S-100蛋白表达的影响

目的观察不同深低温停循环方法对脑组织S—100蛋白表达及组织结构的影响。方法将18只实验犬随机分为3组，深低温停循环（deep hypothermic circulatory arrest，DHCA组）组，深低温停循环结合逆行脑灌注（retrograde cerebral perfusion，RCP，DHCA＋RCP组）组，深低温停循环结合顺行性间断脑灌注（intermittent antegrade cerebral perfusion，IACP，DHCA＋IACP组）组。3组犬体外循环开始后将鼻咽温降至18℃，随后停循环90min，开放循环后复温至36℃，随后停机。在停循环前、停循环后45min、90min及开放循环后15min和30min由颈静脉插管留取血液标本进行S-100蛋白含量测定。手术结束时取脑海马组织作透射电子显微镜检查，观察脑组织及神经细胞超微结构的变化。结果3组犬在停循环前颈静脉血S-100蛋白含量差异无统计学意义（P〉0．05），停循环后DHCA组和DHCA＋RCP组S-100蛋白含量较停循环前显著升高（P〈0．01），DHCA＋IACP组S-100蛋白含量停循环前后无显著变化。结论DHCA时间较长时，脑组织会发生缺血缺氧性损伤；RCP对脑组织有一定的保护作用，但易发生脑组织及神经细胞水肿；IACP的脑保护效果较为理想。     

经上腔静脉逆行灌注脑保护在主动脉瘤手术中的应用

目的　探讨在主动脉瘤手术中应用经上腔静脉逆行灌注的脑保护效果。　方法　 65例主动脉瘤患者分 2组 ,15例采用深低温停循环 (DHCA) ,5 0例经上腔静脉逆行灌注 (RCP)进行脑保护。术中比较 2组患者不同时间颈内静脉的血乳酸含量 ,对部分RCP患者测定了灌注血和回流血的流量分布 ,以及灌注血和回流血的氧含量。　结果　DHCA组停循环时间为 10 0～ 63 0min ,平均(3 5 9± 18 8)min ;RCP组为 16 0～ 81 0min ,平均 (45 5± 17 2 )min。术后至清醒时间DHCA组为4 4～ 9 4h ,平均 (7 1± 1 6)h ;RCP组 2 0～ 9 0h ,平均 (5 4± 2 2 )h。DHCA组手术死亡 3例 ,RCP组死亡 1例 ;术后神经系统并发症DHCA组 3例 (死亡 2例 ,成活 1例 ) ,RCP组 1例 (存活 )。手术总成功率和神经系统并发症发生率RCP组分别为 96%和 2 % ,DHCA组为 67%和 2 0 % (P <0 0 5 )。RCP组再灌注期间颈内静脉血乳酸含量增高幅度低于DHCA组 [(4 4± 0 6)mmol/Lvs (6 2± 0 9)mmol/L ,P <0 0 1],经头臂和下腔静脉血流量测定显示约 2 0 %血液经头臂动脉回流 ,灌注血和回流血氧差9 0 0～ 13 67ml/L ,证实RCP期间脑组织有氧利用。　结论　在主动脉瘤手术中 ,应用RCP可以延长停循环的安全时限 ,是可行的脑保护方法     

Does antegrade cerebral perfusion protect the brain during deep hypothermic circulatory arrest?

Purpose

This study compares cerebral protection using no cerebroplegia and using antegrade cerebroplegia with variable flow rates during deep hypothermic circulatory arrest (DHCA).

Methods

Twenty healthy neonatal piglets (2.5-3.8 kg) underwent 60 minutes of DHCA. No cerebroplegia was used in group 1 (n = 5). Cold (16°C) antegrade cerebral perfusate was administered through the innominate artery at 10 mL/kg per minute in group 2 (n = 5), at 25 mL/kg per minute in group 3 (n = 5), and at 50 mL/kg per minute in group 4 (n = 5). Venous samples for lactate, pyruvate, S-100B protein, and creatine kinase BB (CKBB) were drawn from the jugular vein before and after discontinuation of cardiopulmonary bypass—lactate at 5 minutes postbypass, pyruvate at 5 minutes postbypass, S-100B protein at 30 minutes postbypass, and CKBB at 6 hours postbypass. Piglets were killed 6 hours postbypass and their brains were harvested for histological/immunologic studies. Extent of damage was assessed using a semiquantitative score of 0 to 4 based on a validated method.

Results

Evidence for significant apoptosis and necrosis was apparent in all groups. The mean H&E score was 2.2 for group 1, 2.3 for group 2, 2.5 for group 3, and 2.3 for group 4. The mean terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling score was 1.0 for group 1, 1.2 for group 2, 1.7 for group 3, and 0.8 for group 4. Pathological changes were not greater in the piglets that did not have antegrade cerebral perfusion. Serum lactate, pyruvate, S-100B protein, and CKBB did not distinguish between perfusion strategies.

Conclusions

In neonates, unmodified antegrade cerebral perfusion at flow rates of 10, 25, and 50 mL/kg per minute during DHCA does not provide additional protection of the brain as determined by histology, immunology, serum lactate, pyruvate, S-100B protein, and CKBB.     

缺血预适应对体外循环心肌保护作用的临床研究

目的：比较单用冷停博液与缺血预适应（IPC）加冷停搏液联合应用在先天性心脏病心内直视手术中的心肌保护效果。方法：先天性心脏病病人20例，随机分为缺血预适应组（IPC组,n=10)和对照组（n=10),IPC组在阻断升主动脉前实施3分钟缺血－5分钟再灌注的缺血预适应，然后阻断升主动脉，灌注冷（4℃）St Thomas‘停搏液，心脏完全停跳后开始心内手术；对照组则不进行缺血预适应方案。两组均于并行循环前，开放升主动脉心脏复跳后30，60分钟时经Swan-Ganz漂浮导管测定各项血液动力学指标，并观察心肌功能恢复情况；于并行循环前，开放升主动脉时取心肌行超微结构检查及ATP，MDA测定，IPC组还监测缺血预适应期间的心电图及动脉血气变化。结果：（1）CPB后IPC组血液动力学指标恢复快（P＜0．05），心肌收缩有力，血压维持良好，需辅用多巴胺等正性肌力药维持血压的病例明显少于对照组（P＜0．05）；（2）升主动脉开放时IPC组心肌超微结构；ATP等的保护明显优于对照组（P＜0．05），MDA的生成明显低于对照组（P＜0．05）；（3）IPC组阻断升主动脉期间ST段降低（阻断30秒时发生），开放升主动脉后ST段在15秒内完全恢复，此期间均未发现明显心律失常；IPC前后血气结果无明显变化。结论：缺血预适应加冷停博液联合应用具有良好的心肌保护作用。     

不同血气管理与红细胞压积在深低温停循环中对乳猪脑损伤的影响

目的用近红外分光仪(NIRS)观察不同的血气管理和红细胞压积(HCT)对乳猪深低温停循环(DHCA)中脑损伤的影响。方法将24只乳猪根据DHCA期间所采用不同的血气管理和HCT分为4组。A组术中HCT0.25～0.30,降温期pH稳态管理血气,其余各期采用alpha稳态管理血气;B组术中HCT0.25～0.30,alpha稳态管理血气;C组术中HCT0.20～0.25,降温期pH稳态管理血气;D组术中HCT0.20～0.25,alpha稳态管理血气。用NIRS连续监测脑氧合情况,术后6h脑组织固定于甲醛中,并进行组织学评分判断脑损伤程度。结果NIRS指标中,D组脑氧合血红蛋白(HbO2)和总血红蛋白(HbT)在降温期明显低于A组和B组(P<0.05),A组DHCA期间HbO2最低点持续时间(HbO2-NT)明显短。所有HbO2-NT小于25min的乳猪均无脑组织损伤的病理改变。结论DHCA期间采用pH稳态联合高HCT能减轻术后脑损伤。     

Clinical application of retrograde cerebral perfusion for brain protection during surgery of ascending aortic aneurysm--a report of 50 cases

This study was designed to discuss the effects on the brain by different protective methods in ascending aortic aneurysm surgery retrospectively. Two hundred seventy-one surgeries of ascending aortic aneurysm have been done in the past 15 years. There were 65 patients with a dissecting aneurysm of the aortic arch or right arch. To protect the brain, deep hypothermic circulatory arrest (DHCA) combined with retrograde cerebral perfusion (RCP) through superior vena cava (N = 50) and simple DHCA (N = 15) were used during the procedure. Blood samples for lactic acid level from the jugular vein were compared in both groups. Perfusion blood distribution and oxygen content difference between the perfused blood and returned blood were measured in 5 and 10 of RCP patients, respectively. The DHCA time was 35.86 +/- 18.81 min (10 approximately 63 min) and DHCA + RCP time was 45.5 +/- 17.21 min (16 approximately 81 min). The resuscitation time was 7.11 +/- 1.59 h (4.4 - 9.4 h) in DHCA versus 5.43 +/- 2.15 h (2 approximately 9 h) in RCP patients. The operation death rate was 3/15 in DHCA group and 1/50 in RCP patients. Central nervous complication occurred in 3/12 of DHCA patients and 1/49 of RCP patients (p < .01). The overall survival rate was 96% (RCP) versus 67% (DHCA); the central nervous system dysfunction was 20% in DHCA versus 2% in RCP (p < .001). The blood lactic acid level increased significantly after reperfusion in DHCA than that in RCP. The measurement of blood distribution indicated that approximately 2Q% of the perfused blood returned from arch vessels. The difference of oxygen content between perfused and returned blood showed that the oxygen uptake was adequate in RCP group. The application of RCP can prolong the safety duration of circulation arrest. Continuous cerebral perfusion may maintain the brain at a cooler temperature and flush out particulate and air emboli while open anastomosis of the aortic arch to the prosthesis can be safely performed. Therefore, RCP is a preferable method for brain protection in our clinical practices.     

Optimal Perfusion Pressure For Experimental Retrograde Cerebral Perfusion

We evaluated cerebral metabolism during retrograde cerebral perfusion (RCP) and circulatory arrest during profound hypothermia, and also investigated the effects of perfusion pressure on RCP. Twenty-four adult mongrel dogs were placed on cardiopulmonary bypass and cooled to a nasopharyngeal temperature of 20°C. At this temperature, hypothermic circulatory arrest (HCA; n = 6), and RCP with a perfusion pressure of 10 mmHg (RCP10; n = 6), 20 mmHg (RCPPO; n = 6), and 30 mmHg (RCPBO; n = 6) were carried out for 60 minutes. RCP was performed with oxygenated blood via the bilateral maxillary veins, and the retrograde flow rate was regulated to maintain a mean perfusion pressure of 10, 20, or 30 mmHg in the external jugular vein. At 60 minutes of RCP, we measured nasopharyngeal temperature; regional cerebral blood flow (rCBF); cerebral oxygen consumption, carbon dioxide excretion, and excess lactate; cerebral tissue adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP) and energy charge; and cerebral tissue water content. In the RCP10 group, there was excess cerebral lactate, and ATP and energy charge were low. In the RCP30 group, the water content of cerebral tissue was significantly higher than in other groups. In the RCP20 group, temperature was maintained in a narrow range, oxygen consumption and carbon dioxide excretion could be observed, there was no excess lactate, and ATP and energy charge were significantly higher than In the HCA group. In conclusion, RCP can provide adequate metabolic support for the brain during circulatory arrest, and a perfusion pressure of 20 mmHg is most appropriate for RCP. (J Card Surg 1994;9:548–559)     

The effect of short-term coronary perfusion using oxygenated diluted blood following cold storage for long-term heart preservation

BACKGROUND: The aim of this study was to compare the results obtained from the use of both University of Wisconsin (UW) solution and diluted blood in short-term coronary perfusion following 12-hour cold storage. METHODS: Following coronary vascular washout of adult mongrel dogs with the UW solution, the heart was excised and immersed in a cold (4 degrees C) UW solution for 12 hours followed by 1-hour of coronary perfusion. Two different solutions were used for the coronary perfusion; a 4 degrees C oxygenated UW solution (Group U, n=7) and 15 degrees C oxygenated diluted blood (Group B, n=7). Myocardial high energy phosphate (HEP) levels, tissue water content (TWC), interstitial tissue space (ITS) rates and histological findings were evaluated at 0- and 12-hour cold storage and also following coronary perfusion. The preserved graft was then evaluated through orthotopic transplantation. The control group in this experiment consisted of seven hearts transplanted after 12-hour cold storage without coronary perfusion. RESULTS: Myocardial HEP levels significantly decreased after 12-hour cold storage. The recovery rate of myocardial HEP levels after coronary perfusion was significantly (p<0.05) higher in Group B than in Group U. The increase of myocardial TWC during coronary perfusion was significantly (p<0.01) higher in Group B than in Group U. After 1-hour coronary perfusion, the subendocardial ITS rate was significantly (p<0.01) higher compared with the value at 0-hour cold storage in Group U, whereas it demonstrated no significant change in Group B. PAS stain revealed the glycogen content of the subendocardial tissues was higher in Group B than in Group U. The recovery rate of hemodynamic parameters 2 hours after heart transplantation was higher in Group U and significantly (p<0.05) higher in Group B than in the control. CONCLUSIONS: Myocardial HEP levels recovered significantly after additional coronary perfusion. Though the UW solution prevented myocardial cellular edema, subendocardial perfusion was incomplete and the recovery rate of myocardial HEP levels was lower, suggesting that diluted blood may become the solution of choice as a perfusate.     

The effect of diltiazem and dobutamine on myocardial ischemia

The effect of diltiazem and dobutamine on cardiac function and metabolism of the myocardium rendered ischemic for 40 min by occlusion of the left anterior descending coronary artery followed by 15 min reperfusion were studied in 22 dogs. In group D, diltiazem was administered in 8 dogs by a 0.1 mg/kg iv bolus followed by 30 micrograms/kg/min continuous infusion. In D-D group, dobutamine was infused at 5 micrograms/kg/min during reperfusion in 8 dogs. Diltiazem was used in the same manner as group D. Cardiac output was much higher in group D than in the non-treated group C, and heart rate, double product, SVR were reduced but coronary flow was increased in group D. Myocardial tissue Ca2+ in group D was significantly lowered level as compared to group C. Myocardial ATP and CP content were much better preserved in group D than in group C. In group D-D, dobutamine enhanced cardiac function without depletion of myocardial high-energy phosphate but tissue Ca2+ was slightly increased. Myocardial ischemic changes in the ultrastructure were much better protected in group D and D-D than in group C. In group C and D-D, reperfusion-induced arrhythmias were significantly reduced.     

Restoration of ATP contents in the transplanted liver closely relates to graft viability in dogs

Searching for a marker of graft viability, adenosine triphosphate (ATP) content in the graft tissue was measured sequentially during orthotopic liver transplantation (OLT) in 24 adult mongrel dogs. According to the survival period, 12 recipients were divided into two groups: group I - early-death group (n = 6), death within 3 days after OLT and group II - survival group (n = 6), survived more than 7 days after OLT (average 12 days). Serum biochemical findings showed no differences between the two groups except that the prothrombin time on the first postoperative day in group I was significantly longer (p less than 0.05). The ATP content ratio (% of initial value) was significantly higher in group II, compared to that of group I (p less than 0.05), 94 versus 53% at 10 min after perfusion, 31 versus 17% at just before recirculation, respectively. The ATP content ratio recovered significantly to more than 80% at 10 min after recirculation in group II but only to less than 50% in group I. These results suggest that restoration of ATP content in the liver after graft recirculation reflects the viability of the graft and can serve as an appropriate prognostic marker in cases of OLT.