冷钾稀释血顺灌及逆灌对心肌毛细血管保护效果的动态定量观察

体外循环条件下（降温至３０℃，灌流液４℃），对应用顺灌（主动脉根部灌）和逆灌（冠状静脉窦灌）的２０例风湿性心脏瓣膜病患者左心房肌毛细血管作了动态形态定量观察。结果表明，二组分别观察１５７和１４４个毛细血管，断面变化一致，主要是内皮细胞肿胀，较正常平均增厚０．４０～０．４１μｍ。内皮细胞肿胀始于时相Ⅰ。与原病变和中断心跳有关。时相Ⅳ内皮持续肿胀，而狭窄管腔扩大，是由于复灌注压的作用，内皮肿胀有待复流后期恢复，未见复流障碍。二组差别是，逆灌组管腔扩大提前到时相Ⅲ，内皮肿胀发生率于时相Ⅳ明显降低，显示逆灌的保护效果优于顺灌法。

Dinamical and Stereologecal Obeservation on Protective Effects of Antegrate and Retrograte Perfusion of Cold Potassium Hemodilution on Cardiac Capillary Vessel

Capillary vessels in right atrim(20 cases)of reuroatic valvular patients received ante-or retrograte perfusion of cold potassium hemodilution under extracorporeal circulation were observed dinamically and stereolodically during valvular replacement.The results showed that the capillary vessels section were changed identically (observed)157 and 144 capillary in two groups respectively).The main changes is swelling of endothelial cells,it's thickness increased about 0.40～0.41lμm(average).Endothelial swelling is beginning at phase I.It concerned with the primary pathological changes and the time of stop beating.Endothelial swelling continued to phase Ⅳ,but the constracted lumen was enlarged by the pressure of reperfusion,whereas the swelling of capillary endothelial cells would be recovered at the late stage of reperfusion.No-reflow phenomenon was not observed.The difference between the two groups(ante-and retrograte perfusion) was that under condition of retrograte the lumen enlarged early at the phase Ⅲand the incidence of endothelial swelling markedly decreased at phase Ⅳ,indicting the protective effect of retrograte perfusion is better than that of antegrate.