灌注保存对猪离体供心冠脉和心肌保护效果的研究

目的：观察不同保存方法及不同灌注容量对猪离体供心冠脉血管因子表达和心肌细胞保护效果的影响。方法巴拿马小型香猪共36只，根据保存技术不同分为浸泡保存组和间断灌注保存组，间断灌注容量分别为50、100、150、200、250ml，每组6只。灌注液为30μmol/L二氮嗪强化Celsior液，保存温度为4℃，时间10h。保存后比较各组间冠脉血管中内皮型一氧化氮合成酶（eNOS）、内皮素-1（ET-1）、细胞黏附分子-1（ICAM-1）表达情况，以及心肌细胞凋亡情况、心肌组织ATP含量（ATPC）、心肌含水量（MWC）。结果间断灌注保存各组较浸泡保存组能维持较高的ATP水平，减少心肌细胞凋亡，降低MWC；而eNOSmRNA表达量高于浸泡保存组，ET-1mRNA和ICAM-1mRNA表达量却低于浸泡保存组（P＜0.05）。当灌注容量为50~200ml时，随着灌注容量的增加，ATPC和eNOSmRNA表达量逐渐增高，凋亡指数、MWC、ET-1mRNA和ICAM-1mRNA表达量则逐渐降低；继续增加灌注容量至250ml时，各指标并无显著变化。结论在长时间心脏保存中，每隔2h灌注1次，每次灌注容量为200ml能较好保护供心；当灌注容量低于200ml时，随着灌注容量的增加供心保护效果逐渐增强，且对冠脉和心肌的保护作用具有等同性。

Intermittent perfusion for protection of coronary endothelium and myocardium in isolated pig hearts

Objective To compare the protective effect of different preservation methods on coronary endothelium and myocardium in isolated pig hearts. Methods Thirty six hearts isolated from Bama- miniature- pigs were divided into 6 groups：one static storage group and 5 intermittent perfusion groups with 6 in each group. Isolated heart in storage group were preserved in Celsior cardioplegia solution enhanced with diazoxide （DE, 30μmol/L） at 4℃for 10h;isolated hearts in perfusion groups un-derwent intermittent perfusion with 50,100,150,200 or 250ml solution respectively, every 2 h for 10 h. Then the samples of left ven-tricle and left anterior descending coronary artery were taken and apoptotic cardiomyocytes （AI）, adenosine triphosphate con-centrations （ATPC）, myocardial water content （MWC）, endothelial nitric oxide synthase （eNOS）, endothilin- 1 （ET- 1） and intercel-lular adhesion molecule- 1 （ICAM- 1） were measured. Results Compared with static storage group, the ATPC, eNOSmRNA in perfusion groups were significantly higher and AI, MWC, ET- 1mRNA, ICAM- 1mRNA were significantly lower. ATPC and eNOSm-RNA were gradual y increased and AI, MWC, ET- 1mRNA, ICAM- 1mRNA were gradual y reduced with the perfusion solution in-creasing in a range of 50ml to 200ml. There were no significant differences between 200ml and 250ml intermittent perfusion group. Conclusion Intermittent perfusion of preservation solution provides better protective effect on myocardium and endothe-lium of coronary artery in isolated donor hearts.