20℃低温稀释血停搏液心肌保护效果的实验研究

目的 研究 2 0℃低温稀释血停搏液 (2 0℃HBC)灌注结合体循环自然降温在心脏直视手术中的心肌保护效果。方法 将 14条 15～ 2 0kg成年杂种犬随机分成对照组和实验组 (n =7) ,雌雄不拘。实验组采用间断 2 0℃HBC灌注 ;体温自然降至 32～ 35℃。对照组采用体循环主动降温 ;间断 8～ 10℃稀释血停搏液 (CBC)灌注。于主动脉阻断前、后抽取右房血测乳酸脱氢酶 (LDH)、肌酸激酶同工酶 (CK MB)、肌钙蛋白I(cTn I) ,取左心室心内膜下心肌观察超微结构变化 ,于主动脉阻断前、后监测心功能。结果 两组停搏液灌注后LDH、CK MB、cTn I均升高 ,实验组变化幅度小 (P <0 0 5 ) ;实验组与对照组相比 ,灌注液对心功能影响较小 ,心肌超微结构损伤性变化不明显。结论 在体外循环过程中 ,与CBC相比 ,在心肌酶、cTn I、心肌超微结构方面2 0℃HBC灌注对心肌有较好的保护作用。

应用中度低温含氧血停跳液持续灌注心肌保护法的临床疗效分析

应用中度低温含氧血停跳波持续灌注心肌保护方法对20例各种先天性及风湿性心脏病人进行手术治疗，与低温冷晶体停跳液间断灌注方法相比较，此方法临床上表现开放主动脉后心脏自动复跳车高，脱机顺利，术后低心排综合症发生率低，血流动力学稳定，无手术死亡，表明具有较好的心肌保护效果。

Experimental and Clinical Research of Myocardial Protection Effect Using MHBC Perfusion

Objectives To determine themyocardium -protecting effect of medium hypothermalblood cardioplegia (MHBC); further demonstrates thatthe optimal temperature between these hypothermaland normothermic can overcome the disadvantages;and thus discovers a more effective myocardium pro-tecting method. Methods Section 1: 14 mongreldogs (15-20 kg) were randomly divided into twogroups: experimental group and control group; car-dialpulmonary bypass was conventionally instituted,moderate hypothermia blood cardioplegia was used inexperimental group, Blood samples from right atriumtaken for examination of lactate dehydrogenase (LDH)creatine kinase(CK-MB) and Topin Ⅰ(cTn-Ⅰ). speci-mens of left ventricular subendocardial myocardiumwere biopsied to observe changes of ultrastructure.Section 2: 24 patients were randomly divided into twogroups and both groups received two types of treat-ment (same as Section 1) after aorta cross-clamp(ACC). Biochemical index and Clinical observationwere caculated as the indicators. Results In the ex-perimental research, LDH, CK-MB, cTn-Ⅰ were foundincreased afer reperfusion in both groups, but the ex-tent of changes in experimental group is tiny (statisti-cal difference). Compared with control group the effectof MHBC on cardial function is litile; the ultrastruc-ture. of cardiac muscle has no obvious change. In theclinical research, compared the test results of venousblood drawn before CPB, after beating recovery andafter CPB, CBC perfused group (LDH, CK-MB leak-age and cTn-Ⅰ value increase.) compared with MHBCperfused group had no remarkable difference (P>0.05), but at the result of clinical observation: MHBCperfused group had red, soft hearts after cardiac arrestbut CBC perfused group had pale, spasmatic heartsafter cardiac arrest; 0 case in MHBC perfused groupand 3 cases in CBC perfused group had twitch-re-moving beat recovery; 11 cases in MHBC perfusedgroup and 3 cases in CBC perfused group recoveredsinus heart rhythm after surgery; average consumptionof lidocaine was 16.67 (±55.28) mg for MHBC per-fused group and 118.33(±82.65) mg for CBC perfusedgroup (P<0.01) afer surgery; 4 cases in MHBC per-fused group and 11 cases in CBC perfused group suf-fered arrhythmia after surgery. Conclusions As anew myocardium - protecting method, MHBC perfusionin combination with natural body temperature drop ofCPB is worth clinical dissemination and application.

终末温血灌注对低温缺血再灌注心肌细胞微管蛋白的影响

目的 :研究体外循环低温心肌保护中 ,采用终末温血灌注 (TWBC)对心肌细胞微管蛋白 (TB)组分的影响 ,探讨TWBC心肌保护作用的机制。方法 :建立猫体外循环 (CPB)模型 ,随机分为两组 :组 ,间断冷血心停搏液灌注 (ICBC) ;组 ,先 ICBC,主动脉开放前给予 TWBC。动态观察不同时间点左心室收缩压峰值 (L VSP)、左心室舒张末压 (L VEDP)、左心室内压正负相最大变化速率 [(± dp/ dt) max]及达到最大收缩速率的时间 [(t- dp/ dt) max]。采用 Western杂交技术 ,检测主动脉阻断(ACC) 115、12 0 min、再灌注 5、15、6 0、12 0 m in时心肌 TB含量 ,进行半定量分析。结果 :(1)心脏再灌注 12 0 m in内 ,两组心功能差异显著 (P<0 .0 5 )。 (2 )心肌细胞 TB含量变化 :A CC 12 0 min、再灌注 5 m in时 ,两组游离、聚合 TB含量差异均非常显著(P<0 .0 1)。 结论 :TWBC能加速低温心肌保护中细胞 TB聚合 ,有利于再灌注早期心功能恢复。