L-精氨酸对心肺移植缺血再灌注损伤的保护作用

Effects of L-Arginine on Ischemie-reprefusion Ingury in Heart-Lung Transplantation

目的 研究一氧化氮 (NO)前体L 精氨酸 (L Arg)在心肺移植中对心肺缺血再灌注损伤的保护作用。方法 将 2 0只健康成年犬随机分为 2组 ,每组各 10只 ,每次实验使用受体犬和供体犬各 1只 ,采用标准法行心肺移植 ,心脏灌注Stanford液 ,肺灌注Euro Collins液 ,实验组于Euro Collins液、Stanford液中分别加入L Arg 5 0 0mg/kg ,受体犬主动脉开放前 5min加入L Arg 5 0 0mg/kg于机液中 ,供心肺放入 4℃Euro Collins液保存 4～ 6h。监测心电图 (ECG)、心率(HR)、平均动脉压 (MAP)、肺动脉平均压 (MPAP) ,测定股静脉血中一氧化氮 (NO)、超氧化物歧化酶 (SOD )、丙二醛(MDA)、心肌肌钙蛋白I(cTnI)、乳酸脱氢酶同工酶 (LDH)含量、股动脉血氧分压 (PaO2 ) ,测定肺湿 /干重比 (W /DR)及观察心肺超微结构以评价心肺保护的效果。结果 开放后均为窦性心率 ,实验组PaO2 高于对照组 (P <0 0 1) ,实验组NO、SOD含量较对照组高 (P <0 0 1) ,实验组cTnI、MDA、CKMB、LDH含量较对照组低 (P <0 0 1) ,实验组湿 /干重比小于对照组 (P <0 0 5 ) ,透视电镜检查实验组心肺损伤轻于对照组。结论 应用标准法可成功建立心肺移植动物模型 ,供心肺可安全保存 4～ 6h ,在心肺移植实验中加入L Arg可使NO含量增加 ,从而加强对心肺的?

Objective This study was to investigate the protective effect of L arginine on ischemie reperfusion ingury in heart lung transplantation. Methods 20 adult healthy dogs were randomly divided into two groups. The heart were flushed with Stanford solution, the lung were flushed with Euro Collins solution, in treated group, administration of L arginine to cardioplegic and lung perfusion solution(L Arg 500 mg/kg). Hemodynamic parameters including heart rate(HR), mean artery pressure(MAP), mean pulmonary artery pressure(MPAP), plasma assayed included NO, cTnI, SOD, MDA, LDH, arterial blood for the assay were drawn, the ultrastructural studies of heart and lung. Results After artery untied, all cases were SR, PaO 2 was significantly higher in the treated group than in the control group, the concentration of NO and SOD was signifieantly higher in the control group, the control group, the change of cTnI、 MDA and LDH was adverse. Transmission electron microscopic examination showed the lesions in the treated group was milder than in the control group. Conclusion The heart lung transplantation canine model had be finished successfully using standard method, we had used grafts preserved up to 4～6 hours successfully, administration of L arginine to cardioplegic and lung perfusion solution increased the release of nitric oxide, can Improve protection of heart and lung in heart lung transplantation.