在人心脏换瓣手术中心肌缺血再灌注损伤时能量代谢的变化

Changes of energy metabolism in ischemic myocardium and in reperfusion during human cardiovalvular-transplantation

本文对7例风湿性心脏病患者心脏换瓣手术时,不同阶段心肌能量有关物质的变化进行了研究,按取材阶段分为:Ⅰ心脏停跳立即、Ⅱ停跳后40分钟、Ⅲ复跳即刻和Ⅳ复跳后20分钟四个时点。在上述时间分别采取右心房切口处微量心肌样品,经处理用快速等浓度洗脱的高效液相色谱技术(HPLC),测定各组心肌样品中能量有关物质:肌酸(Cr)、磷酸肌酸(PCr)、次黄嘌呤(Hypo)、尼克酰胺腺嘌呤二核苷酸(NAD)、腺苷一磷酸(AMP)、腺苷二磷酸(ADP)和腺苷三磷酸(ATP)含量。结果表明:ATP含量是复跳20分钟<复跳即刻<停跳40分钟<停跳立即。PCr也有相同的变化趋势。与ATP比较ADP、AMP、Cr和Hypo呈负相关变化;NAD亦有降低趋势。综上所述,心脏外科手术中,目前采用的高钾晶体稀释血低温保护液对心肌的保护作用,从能量有关物质的变化来看,尚显不足,有待进一步改进。

Changes of energy metabolism in ischemic myocardium and in reperfusion was investigated by high performance liquid chromatography (HPLC) during human cardiovalvular-transplantation. The experiment was divided into four periods: I. At the time of heart stop beating; Ⅱ. 40 min after stop beating; Ⅲ. Right at heart beat restoring and Ⅳ. 20 min after heart beat restoring. Results showed that change of ATP content was I> Ⅱ> Ⅲ> Ⅳ, change of phosphocreatine (PCr) content was very similar to that of ATP. Content of ADP, AMP, Cr and HYPO was negatively correlated to ATP content. NAD content was also reduced. In summary, recently proposed hyperkalemic crystalloid dilluted blood protecting myocardium would not be sufficient enough and further improve- ment is quiet neccessary.