体外循环中去白细胞血再灌注对犬缺血心肌能量代谢的影响

Effect of Reperfusion Leukocyte-depleted Blood on Canine Myocardial Energy Metabolism Balance during Cardiopulmonary Bypass

目的观察去白细胞血再灌注对犬体外循环(CPB)中心肌能量代谢的影响。方法18只犬随机分为对照组、全血组和去白细胞血组(去白组)。分别于CPB前、阻断40min、阻断60min、开放30min和开放60min时,取心肌进行腺苷酸含量、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、髓过氧化物酶(MPO)、丙二醛(MDA)和线粒体肿胀度检测。结果去白组在阻断60min、开放30min和60min时SOD、GSH-PX、腺苷酸含量高于对照组和全血组(P<0.01),而MPO、MDA和线粒体肿胀度均低于对照组和全血组(P<0.01)。结论CPB中心肌能量代谢障碍,而应用去白细胞血再灌注缺血心肌能够明显改善缺血心脏的能量代谢,保护线粒体的结构与功能,从而减轻心肌缺血再灌注损伤。

Objective To investigate the impact of myocardial energy metabolism of canine reperfused with leukocyte-depleted blood during cardiopulmonary bypass （CPB）, Methods Eighteen adult healthy dogs undergoing CPB were randomly divided into 3 groups： the control group （group C, n= 6）, whole blood （group W, n=6） and the experimental group （group L, n=6） with use of the leukocyte depletion filter （LDF） on the bypass circuit. The contents of adenine nucleotide, superoxide dismutase （SOD）, glutathione peroxidase （GSH-PX）, myeloperoxidase （MPO）, malondialdehyde （MDA） and mitochondrial swelling of myocardia were determined respectively before cross-clamping, at 40 min and 60 min after aortic cross-clamping （AC）, 30min and 60 min after declamping （DC） during CPB. Results Reperfused with leukocyte-depleted blood by LDF connected with bypass circuit, the dog hearts of group L at 60min after AC, 30 min and 60 min after DC were much better in the recovery of myocardium energy metabolism, higher in contents of myocardium SOD and GSH-PX than those in group C and W （P〈0.01）. The myocardium MPO, MDA and mitochondrial swelling degree at 60 rain after AC, 30 min and 60 min after 19（2 were distinctly lower in group L than those in group C and W （P〈0.01）. Conclusion Myocardium has serious energy exhaustion and deteriorated metabolism during CPB. Myocardial mitochondrial structure and function can be protected and myocardial energy depletion can be reduced by infusion of leukocytedepleted blood to the heart before DC, which can distinctly attenuate myocardial ischemia/reperfusion injury.