冷钾稀释血逆灌对心肌缺血再灌注损伤的保护作用

Myocardial protective effect of cold potassium hemodilution in retroperfusion

本文对７例进行换瓣手术的风湿性心脏病患者，采用冷钾稀释血冠状静脉窦逆行灌注方法保护心肌，同时利用ＨＰＬＣ检测了手术不同时点心肌能量有关物质的变化，并以此为指标评价顺灌与逆灌的保护效果。结果提示，逆灌较顺灌保护效果好。表现为逆灌时，手术过程中各时点（除停跳立即外，缺血４０分钟，复跳立即，复跳２０分钟）ＰＣｒ检测表观值各时点比顺灌时高；ＡＴＰ检测表观值在复跳２０分钟时逆灌明显高于顺灌。

Seven cases of rheumatic heart disease were given cold potassium hemodi-lution card ioplegia through coronary sinus in retroperfusi on for myocardial proteetionduring valvular-replacement.In this study,compounds associated with energy metabolismof myocardium were detected by HPLC at various intervals during operation, It wasfound that retroperfusion showed better effect on myocardial protection compared withantegrade coronary perfusion reported previously by the author. At different intervals ofoperation in retroperfusion(40 min after stopped beating, immediately,after beatingrestored,20 min after beating restored ),the apparent content of PCr was higher than thatof antegrade perfusion; ATP was obviously higher in 20 min after beating restored, therehad ben tendencies that ADP,NAD were increasing at each time intervals,TAN andenergy charge showed the similar changes on the contrary,HYPO and AMP showeddecreasing tendency.In summary, cold potassium hemodilution cardioplegia given in retroperfusion wouldfurther improve myocardial energy metabolism,i. e. oxidative phosphorylation of myo-cardium was enhanced in retroperfusion , the increasing of NAD and ADP are benificialto ATP and PCr synthesis.