自体冷血心脏停搏液对未成熟心肌CK-MB、cTnI及细胞线粒体的影响

目的通过对比自体冷血心脏停搏液与HTK液对未成熟心肌释放CK-MB、cTnI及细胞线粒体的影响,提示自体冷血心脏停搏液对未成熟心肌细胞的保护作用。方法年龄≤1岁行体外循环室间隔缺损修补术的患儿40例随机分为两组,实验组20例、对照组20例。主动脉阻断后,分别用自体冷血停搏液、HTK液根部灌注。于心脏停跳前、复跳后30min取右心耳标本1mm×1mm×1mm电镜观察细胞线粒体形态,并用Flameng法评价线粒体损伤程度。另外于术前、术毕、术后24、48h经桡动脉采血检测cTnI及CK-MB。研究上述两组各项指标的差异,运用统计学t检验的方法,得出研究结果。结果术后cTnI和CK-MB均明显升高,其中对照组cTnI和CK-MB升高较多(P<0.01)。主动脉阻断前心肌线粒体基本完好,偶见基质颗粒丢失或线粒体肿胀。主动脉开放后,线粒体出现不同程度损伤样改变,如颗粒丢失或嵴断裂。主动脉开放后两组患儿心肌线粒体Flameng评分显著增高(P<0.01),开放后对照组评分比自体冷血停搏液组明显增高(P<0.05)。结论自体冷血停搏液可减少未成熟心肌释放CK-MB与cTnI。能减轻缺血再灌注对未成熟心肌细胞线粒体的损伤。自体冷血心脏停搏液对未成熟心肌的心肌保护效果明显优于HTK液。

The Effect of Cold Autologous Blood Cardioplegic Solution to Serum Troponin-I & CK-MB Release and Mitochondria of Immature Cardiocyte

Objective Contrasting Serum troponin-I MB isoenzyme of creatine kinase（CK-MB） release and mitochondria of immature cadiocytes effected by cold autologous blood cardioplegic solution and HTK solution,is to demonstrate its protective effect on the immature cadiocytes.Methods 40 children of age under 1-year-old with repair of ventricular septal defect in cardiopulmonary bypass were included and randomly grouped into two units：＂cold autologous blood cardioplegia＂（n=20;Experiment Group） and ＂HTK solution＂（n=20;Control Group） .Right atrial appendage cadiocytes＇ mitochondria evaluated by Flameng＇s method,were observed by electron microscope prior to the aorta clamped（Time 1） and 30 minutes after the aorta unclamping（Time 2） .Serum troponin-I CK-MB is performed at Pre-operation,the moment post-operation,24 hours post-operation and 48 hours post-operation.By studying the differences in the two groups of indicators,results is obtained by the use of statistical t test method.Results Serum troponin-I CK-MB is increased in both groups（P〈0.01） ,particularly in the control group（P〈0.01） .The structure of mitochondria maintained as originally.Loss of Matrix granule and swelling of mitochondria is found by chance.At Time 2,damage in mitochondria is found,such as loss of Matrix granule and cristae broken.The scores of evaluation by Flameng＇s are increased in both groups（P〈0.01） .The scores of the control group is higher than the one in experimental group（P〈0.05） .Conclusion Serum troponin-I and CK-MB release was lower after applying autologous blood cardioplegic solution undergoing open heart operation.Reperfusion injury of immature cadiocytes mitochondria is relieved by using autologous blood cardioplegic solution.It plays an important role in recovering energy metabolism of cadiocytes.Immature cadiocytes is protected signifi cantly by autologous blood cardioplegic solution rather than HTK solution.