持续顺行灌注温血停搏液对心肌的保护作用

Experimental studies on the myocardial protective effects of continuous antegrade warm blood cardioplegia administration

目的 研究持续灌注温血停搏液对心肌的保护作用 ,探讨理想的心肌保护策略。方法 69只猫随机分为对照组 (组Ⅰ )、损伤组 (组Ⅱ )和保护组 (组Ⅲ )。观测各组不同时间点心功能、心肌细胞膜ATPase活性及心肌细胞膜蛋白颗粒的形态变化。结果 组Ⅰ各时间点各项指标无明显变化。升主动脉阻断 (ACC)期间 ,组Ⅱ～ⅢNaK -ATPase活性均显著下降 (ACC 15minvsACC 60min ,P <0 0 1) ;组ⅡCaMg -ATPase活性和单位面积心肌细胞膜蛋白颗粒数有一定程度减少 (ACC 15minvsACC 60min ,P <0 0 5 ) ,而组Ⅲ无明显减少 (ACC 15minvsACC 60min ,P >0 0 5 )。复灌后组Ⅲ各项指标均呈恢复趋势 ,其中CaMg -ATPase活性和心功能恢复至正常水平 ,但NaK -ATPase活性和单位面积心肌细胞膜蛋白颗粒数恢复稍差。组Ⅱ复灌后各项指标无明显恢复。结论 单纯体外循环对心功能、心肌细胞膜蛋白无明显损伤 ;持续顺行灌注温血停搏液能较好保护心功能和CaMg -ATPase活性 ,对NaK -ATPase活性和单位面积心肌细胞膜蛋白颗粒数保护作用稍差。理想的心肌保护策略尚需进一步研究。

Objective To study the myocardial protective effects of continuous antegrade warm blood cardioplegia administration, and to explore ideal myocardial protective strategies. Methods Sixty-nine felines were randomized into three groups: the control group (Group Ⅰ), the lesion group (Group Ⅱ) and the myocardial protective group (Group Ⅲ). Cardiac performances and the activities of ATPase on myocardial cell membrane were measured. The morphological changes of myocardial cell membrane-proteins were also observed. Results No significant changes were observed in Group Ⅰ during the course of CPB. Marked decrease in NaK-ATPase activities were seen in both Group Ⅱ and Group Ⅲ during ACC(ACC 15 min vs ACC 60 min, P <0.01). CaMg-ATPase activities and the numbers of myocardial membrane-proteins particles kept stable during ACC in Group Ⅲ (ACC 15 min vs ACC 60 min, P >0.05), but decreased significantly in Group Ⅱ (ACC 15 min vs ACC 60 min, P <0.05). Although the CaMg-ATPase activites and cardiac performances recovered to normal levels in Group Ⅲ after reperfusion for 120 min, the NaK-ATPase activities and the numbers of myocardial membrane-proteins particles were still at low levels. No evidences showed that there is a recovery tendency in Group Ⅱ after reperfusion. Conclusion CPB with ACC does not exert detrimental efforts on the cardiac performances and myocardial membrane-proteins. The CaMg-ATPase activities and cardiac performances are in good condition under the protection of continuous antegrade warm blood cardioplegia administration, but the NaK-ATPase activities and the mumbers of myocardial membrane-proteins particles can not be protected sufficiently by the same methods. Further studies are warranted for the ideal myocardial protective strategies.