腔内分流栓在大鼠腹腔异位心脏移植中的应用

Application of an intraluminal shunt to abdominal heterotopic heart transplantation in rats

目的探讨血管腔内分流栓在建立大鼠腹腔异位心脏移植模型中应用。方法雄性SD大鼠40只,分为传统组和改进组,各20只,采用2%戊巴比妥钠麻醉。供体大鼠经口气管插管,正中开胸后机械通气。经右颈总动脉插入的20G钝针头推注4℃HTK液10 mL左右致使心脏停搏。获取供心后将其放入4℃HTK液保存。传统组仍采用经典大鼠腹腔异位心脏移植术进行手术。改进组采用如下方法:分别夹闭下腔静脉及腹主动脉,切开血管后置入分流栓并固定其两端。将供体的主肺动脉、升主动脉与受体的下腔静脉、腹主动脉做吻合。再次夹闭下腔静脉及腹主动脉,取出分流栓后排气收线打结,确认无出血后开放血管夹。结果改进组手术成功10只,供心存活72 h以上,无下肢缺血及截瘫发生,未发现吻合口。传统组手术成功9只,1只死于术后吻合口出血。两组的总手术时间无明显差别。改进组在下肢肌肉组织病理表现、总缺血时间、CKM及LDH的含量等优于传统组。结论在大鼠腹腔异位心脏移植术中,应用腔内分流栓可使血管阻断的时间缩短,吻合血管的难度下降,手术的成功率增加。

Objective To explore the application of intraluminal shunt in the establishment of heterotopic heart transplantation model in rats.Methods Forty male SD rats were divided into traditional and improved groups,each with 20 rats.Rats were anesthetized by an intraperitoneal injection of 2%pentobarbital sodium.The donor rats were intubated through their mouth and mechanical ventilation was provided after thoracotomy.A 20G needle inserted through the right common carotid artery was used to inject about 10 mL of 4℃HTK solution to induce cardiac arrest.After obtaining the donor heart,it was placed in 4℃HTK solution for preservation.In the traditional group,the classic abdominal heterotopic heart transplantation was still established.The following method were used in the improved group.In the improved group,the inferior vena cava and abdominal aorta were clamped.The shunt was inserted into the vessel and fixed at both ends.The donor’s main pulmonary artery and ascending aorta were anastomosed with the recipient’s inferior vena cava and abdominal aorta.The inferior vena cava and abdominal aorta were occluded again.After removing the shunt,the suture was tightened and knotted.After confirmation of no bleeding,the clamps were opened.Results In the improved group,10 rats were operated successfully.The donor heart survived for more than 72 hours.There was no ischemia,paraplegia or anastomotic bleeding in improved group.In the traditional group,nine rats were operated successfully with one dying of anastomotic bleeding.The improved group was better than the traditional group in terms of lower lamb muscle histopathological manifestations,total ischemic time,CKM and LDH content.Conclusions In abdominal heterotopic heart transplantation of rats,the use of the intraluminal shunt shortened the time of vascular occlusion,reduce the difficulty of vascular anastomosis,and increased the success rate of the operation.