体外循环下不停跳供心保存植入的效果评价

Evaluation on Effects of Donor Heart Preservation for On-Pump Beating-Heart Transplantation

目的评价猪供心在体外循环下不停跳温血连续灌注保存方法与单纯UW液冷保存方法的植入效果。方法选取广西巴马小型猪24头,随机分为两组,体外循环下不停跳温血连续灌注供心保存移植组(不停跳组,供、受体各6头)和单纯UW液冷保存移植组(冷保存组,供、受体各6头)。两组供心取出后,分别采用体外循环下不停跳温血连续灌注保存法及单纯UW液冷保存8 h,然后按标准原位心脏移植方法植入受体猪。记录两组供心植入主动脉开放2 h后心脏自动复跳、除颤情况,测量主动脉开放2 h末的左右心室功能,观察体外循环后30 min血流动力学参数的变化。结果供心植入受体后,主动脉开放3 min内,不停跳组6头心脏全部自动复跳;冷保存组6头均未能自动复跳,心脏除颤12次;两组心脏自动复跳率差异有统计学意义(P<0.05)。主动脉开放2 h,左右心室收缩压不停跳组优于冷保存组(P均<0.05);体外循环后30 min,中心静脉压(CVP)、肺毛细血管楔压(PCWP)不停跳组低于冷保存组(P均<0.05);心输出量(CO)、心脏指数(CI)不停跳组高于冷保存组(P<0.05),多巴胺用量、异丙肾上腺素用量不停跳组明显减少(P均<0.05)。结论体外循环下不停跳温血连续灌注供心保存方法,使原位心脏移植后受体猪早期获得更良好的心功能及血流动力学稳定。

Objective To study the effects of donor heart preserved with continuous on-pump beating-heart warm-blood perfusion and University of Wisconsin （UW） solution on hemodynamics and cardiac function after transplantation in pigs.Methods Twenty-four Bama miniature pigs were randomly divided into two groups：In beating-heart group （n=12）,donor hearts were stored by on-pump perfusion with warm blood;In cold UW storage group （n=12）,donor hearts were stored in cold UW solution .There were six pigs for donors and six for recipients in each group .Donor hearts were stored for 8 hours after isolation,and then were implanted into recipient pigs by orthotopic heart transplantation . Automatically rebeating of implanted heart and the frequency of defibrillation in both groups were recorded two hours after the aortic cross-clamp released,left and right ventricular function were measured as well .The changes of hemodynamics were observed 30 minutes after cardiopulmonary bypass.Results After being implanted into recipient pigs,6 donor hearts recovered automatic-beating 3 minutes after the aortic cross-clamp released in the beating-heart group;All of 6 donor hearts did not recovered automatic-beating in the cold UW storage group,and the frequency of defibrillation accounted for 12;Significant difference was found in the automatically rebeating rate of implanted heart between two groups （P〈0.05）.Two hours after the aortic cross-clamp released,left and right ventricular systolic pressure in the beating-heart group were significantly better than those in the cold UW storage group （all P〈0.05）;Thirty minutes after cardiopulmonary bypass, central venous pressure （CVP） and pulmonary capillary wedge pressure （PCWP） in the beating-heart group were significantly lower than those in the cold UW storage group （all P〈0.05）;Cardiac output（CO） and cardiac index（CI） in the beating-heart group were significantly higher than those in the cold UW storage group （P〈0.05）,and the dosages of dopamine and isoprenaline in the beating-heart group decreased significantly （all P〈0.05）.Conclusion The heart preservation with continuous on-pump beating-heart warm-blood perfusion can make recipient pigs which receive orthotopic heart transplantation get better cardiac function and stable hemodynamics in the early stage .