终末热灌注对心脏移植术中猪供体心脏的保护作用

Effects of terminal warm cardioplegia perfusion in pig's donor hearts undergoing heart transplant

目的:观察终末热灌注对心脏移植术中猪供体心脏的保护作用。方法:12对配型成功的同家系瑞典猪随机分为实验组与对照组,每组6对,分别行心脏移植术。对照组手术完成后正常放开主动脉钳恢复心脏灌注,实验组则在开放主动脉前经历短暂的终末热灌注再恢复灌注。分别于供体心脏缺血前,恢复灌注5 min、30 min、1 h及2 h取冠状窦口和主动脉根部血样,监测冠状动脉血流量,记录血样中氧分压及乳酸含量;在恢复灌注时及恢复灌注4、12、24 h分别抽取猪颈内静脉血样检测肌钙蛋白T。结果:2组恢复灌注后冠状动脉血流量间差异无统计学意义(F组间=2.193,P=0.173)。2组心脏氧利用率,不同时间点间心肌乳酸利用量及血浆肌钙蛋白T浓度差异有统计学意义(F组间=9.041、F时间=44.844和138.908,P<0.05);实验组心脏氧利用率更早恢复正常,在恢复灌注5min,实验组心肌乳酸利用量低于对照组,在恢复灌注24 h,实验组血浆肌钙蛋白T浓度低于对照组(P<0.05)。结论:心脏移植术中终末热灌注可降低心脏无氧代谢水平,促进心肌细胞功能恢复,减轻心肌损伤。

Aim： To investigate the effect of the terminal warm cardioplegia perfusion（TWCP） in pig＇s donor hearts undergoing heart transplant. Methods： A total of 24 Swedish domestic pigs were randomly allocated into two groups： the control group and the TWCP group with 12 in each group. In the control group the cross clamp was released immediately after the completion of heart transplant. In the TWCP group the donor hearts were perfused with warm cardioplegia for 2 rain prior to removal of the cross clamp. Blood samples were collected from coronary sinus and aortic root before placed the cross clamp. The quantification of lactate and oxygen saturation, and the blood flow in the coronary artery were monitored before reperfusion and at 5 min,30 min, 1 h and 2 h after reperfusion. Myocardial troponin T in the blood samples of the internal jugular vein was determined after releasing the cross clamp, and at 4,12, and 24 h after reperfusion. Results： The results showed no significant difference in blood flow of the coronary artery between the two groups （Fgroup = 2. 193 ,P = 0. 173 ）. There were significant differences in lactate accumulation and myocardial troponin T concentration after surgery （Ftime =44. 844 and 138. 908） ;compared with control group, the oxygen utilization of the TWCP group recovered earlier, the lactate accumulation of the TWCP group was reduced, and the myocardial troponin T concentration in the TWCP group was reduced after 24 h reperfusion（P 〈0.05）.Conclusion： In heart transplant, TWCP reduces myocardial anaerobic metabolism, promotes myocardial functional recovery and reduces myocardial injury.