温血灌注对心肌的保护作用

Warm blood cardioplegia for myocardial protection

实验用两组犬行主动脉根部持续灌注氧合血停搏液,分析温血(37℃)和冷血(4℃)的保护效果。结果显示乳酸脱氢酶(LDH)、肌酸磷酸酶(CPK)、血清谷草转氨酶(SGOT)在温血组中明显低于冷血组,且温血组中丙二醛(MDA)含量也低于冷血组,提示持续氧合温血灌注心肌可减轻心肌再灌注损伤。

Hypothermia has been considered to be detrimental to myocardial protection. In order to evaluate warm blood cardioplegia effects, following CPB, 12 adult mongrel dogs were randomly allocated to be continuously perfused through aortic root with oxygenated warm blood cardioplegia (37 C) (group W, n=6)or cold blood cardioplegia (4C)(group C,n=6)indivadually. The coronary blood samples were taken before coronary perfusion(CP), 60mins and 90mins following CP,to measure the serum activities of lactate dehydrogenase (LDH),creatine phosphokinase (CPK)and glutamic-oxaloacetic transaminase (GOT)and the level of malondialdehyde (MDA). As compared with those before CP,the activities of LDH and CPK increased significantly only at 90th min following CP in group W,and at 60th and 90th min during CP in group C(P<0.05);the CPK activity kept stable in group W(P>0.05) but went up markedly in group C following CP(P<0.05);the MDA level changed unsignifieantly in group W (P>0.05) but rose dramatically in group C (P<0.05). After aortic clamping removal,the spontanous restoration of beats occured in all 6 subjects of group W and only in 2 subjects of group C. It is suggested that continuous oxygenated warm blood cardioplegia may effectively reduce myocardial ischemia and reperfusion injury.