逆行灌注心脏不停跳心肌保护的实验研究

Experimental study of cardial protection with retrograde coronary sinus perfusion in beating heart

目的 探讨逆行灌注心脏不停跳心肌保护的效果。方法 中国大白兔 3 2只随机分为 4组 ,每组 8只 ,A组 (对照组 ) ,B组 (心脏不停跳组 ,血温 3 4℃ ) ,C组 (温血心脏麻痹液组 ,血温 3 4℃ ) ,D组 (冷血心脏麻痹液组 ,血温 4℃ )。采用离体兔心左室做功模型 ,经冠状静脉窦逆行灌注稀释血液或血停搏液 60min。比较观察心功能、冠脉排出液心肌酶谱、心肌组织乳酸、心肌细胞内游离钙浓度、心肌细胞膜ATP酶活性、心肌细胞膜脂质过氧化产物丙二醛含量的变化。结果 B组心功能恢复、心肌细胞膜ATP酶活性显著优于C组和D组 ,C组优于D组 ;B组心肌酶漏出、乳酸生成量、心肌细胞内游离钙浓度、心肌细胞膜丙二醛 (MDA)含量低于C组和D组 ,C组低于D组。结论 常温氧合血逆灌心脏不停跳良好的心肌保护效果与其减轻自由基损伤 ,较好地保持细胞内外Ca2 + 平衡 ,减轻细胞内钙超载 ,保护细胞膜酶功能有关。

Objective To study the myocardial protective effects of retrograde coronary sinus perfusion in beating heart. Methods Isolated rabbit working heart models were used in this study. Thirty two isolated rabbit hearts were randomized to four groups, group A received antegrade perfusion with KH, group B were maintained heart beating by retrograde perfusion with normothermic oxygenated blood, group C received retrograde coronary sinus perfusion with warm blood cardioplegia, group D with cold blood cardioplegia. After retrograde perfusion for 60 min, the hearts were switched on Langendorff Neely antegrade perfused working heart model for another 60 min. The cardiac function, myocardial enzyme leak, myocardial content of lactate, intramyocyte free calcium, ATPase of myocardial membrane and MDA of myocardial membrane were measured. Results ① After retrograde coronary sinus perfusion, recovery of cardiac funtion, activity of ATPase of the myocardial membrane in group B was superior to those of group C and D. Recovery of group C was better than group D. ② The leak of CK, LDH, myocardial content of lactate and MDA, and the intramyocyte calcium after retrograde perfusion was much lower in group B than those of group C and D. Conclusion Myocarial protective effects of retrograde normothermic oxygenated blood perfused beating heart is superior to those perfused with cold blood cardioplegia or warm blood cardioplegia.