冷停搏液冠状静脉灌注保护缺血心肌的实验研究  

The Experimental Study of Cold Coronary Sinus Cardioplegia for the Protection of Ischemic Myocardium

作　　者：傅新平[1] 张凯伦[1] 叶世铎[1] 熊希凯[1] 蓝鸿钧[1] 邵友梅 徐志娟[1] 

机构地区：[1]武汉同济医科大学心研所,海南医学院附属医院心外科

出　　处：《中华胸心血管外科杂志》1995年第1期45-47,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：采用左前降支（ＬＡＤ）梗阻心肌缺血模型，２４只杂种犬依冷停搏液灌注方法分为４组，即主动脉灌注（ＡＰ）、右房灌注（ＲＡＰ）、冠状静脉窦灌注（ＣＳＰ）、主动脉灌注加冠状静脉窦堵塞（ＡＰＣＳＯ），每组６只。结果表明，冠状静脉灌注（ＲＡＰ、ＣＳＰ、ＡＰＣＳＯ）均明显增加有ＬＡＤ梗阻时缺血心肌保护。缺血时梗阻ＬＡＤ区心温维持较低；缺血后心电图恢复正常，心肌组织有氧代谢标志酶—琥珀酸脱氢酶（ＳＤＨ）保持较高活性（＋＋＋～＋＋＋＋），心脏指数（ＣＩ）和左室搏出功指数（ＬＶＳＷＩ）恢复较佳。相反，ＡＰ对梗阻ＬＡＤ区心肌不能提供足够的心肌保护。缺血时对ＬＡＤ区降温差；缺血后心电图Ｓ－Ｔ段明显抬高，ＳＤＨ活性减弱（＋），无氧糖酵解标志酶—乳酸脱氢酶活性增高（＋＋＋），ＣＩ和ＬＶＳＷＩ恢复较差。Twenty four canine models of myocardial ischemia produced by obstruction of left anterior descending branch(LAD)of the coronary artery were equally divided into four groups according to the ways of cold cardioplegic perfusion:aortic perfusion(AP),right atrial perfusion(RAP),coronary sinus perfusion(CSP)and aortic perfusion with coronary sinus occlusion(APCSO).Results showed that coronary sinus perfusion including RAP and APCSO significantly enhanced protection of ischemic myocardium in the presence of LAD obstruction.Myocardial temperature in the occluded LAD region was kept much lower during ischemia. After ischemia,electrocardiogram became normal,a higer activity(+++～++++)of succinate dehydrogenase(SDH),a key enzyme of aerobic metabolism in the myocardium,was maintained and cardiac index(CI) and left ventricular stroke work index(LVSWI)showed better recovery.On the other hand,AP could not provid an adequate myocardial protection for the occluded LAD region.LAD region was cooled much less during ischemia.After ischemia S-T segments were obviously elevated,activity of SDH decreased(+)and that of lactate dehydrogenase(an important enzyme in anaerobic(glycolysis)increased(+++),and recovery of CI and LVSWI was worse.

关 键 词：心肌保护 冷停搏液 主动脉灌注 冠状静脉窦灌注 

分 类 号：R965[医药卫生—药理学] R972[医药卫生—药学]