两种不同心肌保护液对缺血心肌及微血管形态学的影响

A comparison of effects of St. Thomas No. 1 solution and modified Collins solution.on ischemic myocardi-um and microvasculature.

目的实验用St.Thomas Ⅰ号液(Ⅰ组,K^+20mmol/L,6例)和改良Collins液(Ⅱ组,K^+115mmol/L,6例)灌注猪心并保存于4℃该液中,观察其对不同保存时间心血管形态学的变化。方法分别于灌注后即时、4、6、7小时和保存4、5小时后离体心脏再灌注复苏30分钟后,行冠脉墨汁灌注、取心室肌组织学切片,电脑图像分析心肌微血管密度(Vd)、观察其超微结构。结果在保存及再灌注复苏各阶段中,Ⅰ组Vd始终高于Ⅱ组,灌心停液和保存末及再灌注后Ⅰ组、Ⅱ组均有水肿,Ⅱ组明显。超微结构观察,保存末线粒体等结构组间无明显差异,再灌注后两组血管内皮水肿减轻,Ⅰ组细胞核形态、线粒体水肿、糖元颗粒减少、闰盘间隙增大等改变均轻于Ⅱ组。心肌、血管内皮细胞无不可逆损害。结论极度高钾对心肌微血管形态、心脏水肿、超微结构均产生不利影响。

Objective The porcine hearts were flushed and immersed by 4 C St. Thomas No. 1 solution (group 1, K^+20mmol/L, n=6) and modified Collins solution (group 2, K^+115mmol/L, n=6) to observe the morphologic changes in ischemic myocardium and microvasculature. Methods After preserved for 4-7 h, all isolaled porcine hearts received coronary ink perfusion and 4 of the isolated hearts were reperfused and resuscitated. Results The morphologic changes of myocardium and microvasculature were studied. The microvascular drnsity in group 1 was higher than that in group 2 (P<0.001). At the end of preservation, the edema was found. However, after reperfusion and resuscitation, the edema and scarcely glucose granule were more severe in group 1 than in group 2. No obvious difference in myocardial ultrastructures, nuclear chromatin marginated and chondriosome edema was more severe in group 2 than in group 1. Conclusion Extremely hyperpotassium is more harmful to myocardial and endothelial ultrastructure.