改良心肌保护液对短暂常温热缺血供心移植后的保护作用

THE PROTECTION EFFECTS OF MODIFIED COLD CARDIOPLEGIA FOR TRANSIENT WARM ISCHEMIAL MYOCARDIUM

①目的 探讨改良心肌保护液对短暂常温热缺血供心移植后的保护作用。②方法 1 8只家猪随机分为 3组 ,对照组 (C组 ) :供心低温灌注Thomas保护液后切取心脏 ,4℃保存 4h后行原位心脏移植 ;热缺血组 (W组 ) :供心低温灌注Thomas保护液前常温缺血 5min ,4℃保存 4h后行原位心脏移植 ;改良心肌保护液组 (E组 ) :供心常温缺血 5min后用改良保护液灌注 ,4℃保存 4h后行原位心脏移植。以心排血量 (CO)、心肌含水率、丙二醛 (MDA)、ATP、肌钙蛋白I(cTnI)水平和心脏超微结构作为观察指标。③结果 E组心肌含水率、MDA含量和cTnI含量明显低于W组 (F =4 .0 1～ 5 .78,q =2 .5 5～ 3.2 2 ,P <0 .0 5 ) ;E组CO和ATP含量明显高于W组 (F =4 .82～ 5 .6 3,q =2 .80～ 3.1 2 ,P <0 .0 5 ) ;E组与C组各指标相比差异无显著性 (q=1 .90～ 2 .4 8,P >0 .0 5 ) ;超微结构显示 ,E组心肌损伤较W组明显减轻。

Objective To evaluate the protective effects of modified cold cardioplegia on warm ischemia myocardium. Methods Eighteen pigs were randomly divided into three groups: control group (Group C), in which the donor hearts were arrested and stored for four hours in 4 ℃ Thomas solution; warm ischemia group (Group W), the donor hearts had 5 min of warm ischemia before the arrest and preservation in 4 ℃ Thomas solution; modified cold cardioplegia group (Group E), the donor hearts had 5 min of warm ischemia after the arrest and preservation with 4 ℃ modified cold cardioplegia. An othortopic heart transplantation was performed in each group. Cardiac output (CO), myocardial water content (MWC), malondiadehyde (MDA), adenosine triphosphate (ATP), cardiac proponin I (cTn I), and myocardial ultrastructure were detected. Results MWC, MDA contents and cTn I in Group E were lower than those in Group W ( F=4.01-5.78,q=2.55-3.22, P <0.05). CO and ATP contents in Group E were higher than those in Group W ( F=4.82-5.63,q=2.80-3.12, P <0.05). There were no significant differences between Group E and Group C ( q=1.90-2.48, P >0.05).The myocardial ultrastructure injury was milder in Groups E than in Group W. Conclusion Modified cold cardioplegia gives more protections for warm ischemia donor heart in both structure and function.