不同灌注方法对原位猪心移植术心肌缺血再灌注损伤的影响

目的研究原位猪心移植中,不同灌注方式对心肌的保护效果,探讨较理想的心肌保护方法。方法 将24对家养猪随机分为两组;冷血组(n=12对),采用4℃含氧合血心脏停跳液间断灌注;温血组(n=12对),用36℃含氧合血停跳液诱导心肌停跳,冷血维持,终末温血灌注保护心肌,分别于体外循环(CPB)前(T1)、开升主后30min(T2)、60min(T3)、停机时(T4)抽取中心静脉血,离心后测定两组血浆心肌肌钙蛋白T(cTnT)、内皮素-1(ET-1)、丙二醛(MDA)、超氧化物歧化酶(SOD)浓度和心肌复跳后的血流动力学指标。结果 体外循环后,冷血组血浆中的cTnT、ET-1、MDA较温血组明显增高,心脏复跳后血流动力学指标恢复至基础值水平温血组优于冷血纽,且SOD保持较高的活性。结论 冷温氧合血停跳液联合灌注,能够减轻心肌再灌注损伤,有利于术后心脏功能迅速恢复。

Myocardial Protective Effect of United-Infusion of Cold and Warm Cardioplegia during Heart Transplantation

Objective To investigate the protective effect of united-infusion of cold and warm blood cardioplegia solution on myocardium during heart transplantation and find the effective method of myocardial preservation. Methods 24 pairs pigs were randomly divided into two groups : cold blood cardioplegia solution group (n = 12 pairs), infusion with cold blood cardioplegia; warm blood cardioplegia solution group(n = 12 pairs) ,infusion with cold blood cardioplegia,combined with warm blood cardioplegia immediately after aortic clamping and just before aortic unclamping. Venous blood samples were taken before cardiopulmonary bypass(CPB) (T1) ,30 min and 60 min after aortic release (T2 and T3), immediately discontinuation of CPB(T4)for determination of plasma levels of cTnT,ET-l ,MDA,SOD. Hemodynamic parameters were observed after recovery of heart beat. Results In cold blood cardioplegia group cTnT,ET-l ,MDA levels were significantly higher than those in warm blood cardioplegia group. SOD activity was lower significantly in cold blood cardioplegia group than in warm blood cardioplegia group. Hemodynamic parameters returned more effectively to the baseline in warm blood cardioplegia group than in cold blood cardioplegia group. Conclusion United-infusion of warm and cold blood cardioplegia is more effective in reducing ischemia-reperfusion injury during heart transplantation.