长冷缺血时间对心脏移植供心超微结构的影响

 目的 观察长冷缺血时间对离体供心超微结构的影响，为临床心脏移植供体的合理利用提供资料。方法 将离体供心置于低温器官保存液（the University of Wisconsin solution，UW液）中保存，分别于冷缺血时间6、8、10、12及14 h取部分左心室心肌和冠状动脉在电镜下观察超微结构的变化。结果 供心缺血时间6 h，心肌细胞及冠状动脉内皮细胞超微结构基本正常。随着缺血时间的延长，心肌细胞及血管内皮细胞出现损伤性改变。供心缺血超过12 h，心肌肌丝断裂，心肌细胞出现局灶性坏死，血管内皮细胞完全脱落。结论 心肌超微结构的改变是衡量供心质量的重要指标。供心冷缺血时间10 h以内，心肌损伤程度较轻，供心可用于移植。缺血时间超过10 h，心肌超微结构出现不可逆损伤改变明显增多，供心将不宜用于移植。

Influence of long cold ischemia preservation time on ultrastructural morphology of donor heart

Objective To investigate the impacts of long cold ischemic preservation time on the ultrastructural changes of donor heart and to provide the data for expanding the heart donor pool. Methods Heart was obtained from brain dead donor and preserved in the the University of Wisconsin (UW) solution at 4℃. Cardiac tissues were harvested at different time points of cold ischemic preservation (6, 8, 10, 12, 14 h) and observed under electron miscroscope. Results Donor heart did not have significant pathologied and ultrastructural changes when cold ischemic preservation time was 6 h. After that, time related impairment of myocardia and endothelium of coronary artery was seen.When ischemic time was longer than 12 h, focal myocardial necrosis and complete loss of the endothelium were detected. Conclusions Myocardial ultrastructure is an important index to evaluate the donor heart quality. Heart, which underwent 10 h of cold ischemia preservation time, causes no significant irreversible and pathological ultrastructural changes, and could be used for heart transplantation. When ischemia time was over 10 h, the donor heart presented with irreversible change and was nolonger unsuitable for transplantation.