常温体外循环下常温充氧晶体和氧合血停搏液持续灌注的心肌保护效果

Myocardial protective effects of continuous infusion with normothermic oxygenated crystalloid solution or blood cardioplegia during normothermic cardtopulmonary bypass

对比研究常温体外循环下常温充氧晶体和氧合血停搏液持续灌注对阻断升主动脉后犬心肌的保护效果。15只犬随机分三组,每组5只,即低温体外循环冷停搏液间断灌注组(对照组);常温体外循环常温氧合血停搏液持续灌注组(温血组);常温体外循环常温充氧晶体停搏液持续灌注组(温晶组)。观察了阻断升主动脉前后心肌超微结构、腺苷酸含量(ATP、ADP、AMP)、脂质过氧化物(LPO)、水含量及血流动力学的变化。结果表示,温血组和温晶组在阻断升主动脉15分钟、50分钟及开放循环20分钟时,正常线粒体和糖原含量均明显高于对照组(P<0.05或0.01);阻断50分钟,开放20分钟时ATP含量显著高于对照组;开放20分钟时温血组LPO低于对照组(P<0.05)。恢复循环30分钟,温血组和温晶组CO、SV、LVSW较对照组恢复良好(P<0.05或0.01)。常温两组间上述各指标在阻断升主动脉和开放循环后均无显著差异。提示温血组和温晶组均能较好保护心肌超微结构,防止高能磷酸化合物降解,抑制氧自由基活性,改善心肌功能。认为常温充氧晶体停搏液持续灌注对心肌的保护效果与温氧合血停搏液基本相同,均优于冷停搏液间断灌注技术。

The myocardial protective effect of continuous infusion with normothermic oxygenated crystalloid solution or blood cardioplegia during normothermic CPB was studied in 15 dogs. Ultrastructure. levels of adenine nucleotides,lipid peroxide (LPO),water content of heart musle,hemodynamics were observed. Dogs were randomly divided into three groups. Group Ⅰ: intermittent infusion with cold crystsalloid cardioplegia during hypothermic CPB (n=5); Group Ⅱ: continuous infusion with normothermic oxygenated blood cardioplegia during normothermic CPB(n=5); Group Ⅲ: continuous infusion with normothermic oxygenatde crystalloid cardioplegia duriug normothermic CPB((n=5). The normal mitochandria contents and glycogen stores in group Ⅱ and Ⅲ were significantly higher than those in group Ⅰ(P<0.05 or 0.01) at postischemic 15 min, 50 min and reperfusion 20 min,with no significant difference between group Ⅱ and Ⅲ. And no significant difference was found in myocardial adenine nucleotides, energy charge(EC), LPO and water content between group Ⅱ and Ⅲ at postischemic 15 min, 50 min and reperfusion 20 min, but the levels of ATP and EC were obviously higher than those in group Ⅰ (P<0.05 or 0.01) at posuschemic 50 min and reperfusion 20 min and the LPO in group Ⅱ was lower (P<0.05) than that in group Ⅰ at reperfusion 20 min, The recoveries of CO,SV,LVSW in group Ⅱ and Ⅲ were better than that in group Ⅰ (P<0.05 or 0.01) withoutsignificant difference between group Ⅱ and Ⅲ. The results suggeste that continuous normothermic oxygenated crystalloid cardioplegia has a similar myocardial protection to blood cardioplegia during normothermic CPB,which is superior to the intermittent infusion with cold cardioplegia during hypothermic CPB.