经静脉注射高钾溶液对心脏功能和心肌结构的影响  

Changes on heart function and myocardial structure of non-beating heart caused by hyperkalemic solution injection via vein

作　　者：林宗武[1] 洪涛[1] 宋凯[1] 郑佳予[1] 刘琛[1] 王春生[1] 

机构地区：[1]复旦大学附属中山医院心脏外科,上海200032

出　　处：《复旦学报（医学版）》2006年第3期320-323,共4页Fudan University Journal of Medical Sciences

基　　金：上海市科委重大项目(024119001)资助

摘　　要：目的研究经静脉注射高钾溶液对心脏功能和心肌结构的影响。方法采用经静脉注射高钾溶液致兔心停跳。使用Langendorff非循环式离体心脏灌注模型研究兔心热缺血2min（第1组）、5min（第2组）、10min（第3组）和热缺血5min后使用4℃UW（University of Wisconsin）液灌注并保存4h（第4组）对左心室压力-容积曲线的影响，测定复灌时灌洗液的肌钙蛋白T浓度、复灌后心肌含水量、观察心肌形态和超微结构的变化。结果心脏在热缺血2～10min内。心肌组织缺血损伤随时间的变化稍有加重，左心室功能稍降低。前3组左心室压力无显著差异，第4组左心室功能轻度降低，心肌损伤仍为可逆性改变。结论经静脉注射高钾溶液停跳的心脏在热缺血5min之后使用UW液低温保存4h仍可用于心脏移植。Purpose To explore the effects on cardiac function and myocardial structure of non-beating heart caused by hyperkalemic solution injection via vein. Methods Twenty-four New-Zealand rabbit were randomly divided into 4 groups. All were injected hyperkalemic solution via vein to cause heart arrest. Hearts of each group were left undisturbed in situ for different minutes of warm ischemic time according to our design. Group 1, underwent 2 minutes of warm ischemic time; group 2, 5 minutes; group 3, 10 minutes. Group 4, underwent 5 minutes of warm ischemic time and then the hearts were excised, infused with UW solution via aortic root at 4 ℃ and stored in University of Wisconsin solution for 4 hours at 4 ℃. Each heart was then put on isolated non-recirculating Langendorff model to acquire pressure-volume curve of left ventricle. The first 10mL of outflow reperfusion solution was taken to assay cardiac troponin T （cTnT） concentration and the specimen was made at last for cardiac morphology and ultrastructure observation. Results After hyperkalemic solution injection via vein, the rabbit hearts ceased beating while the blood K^± concentration of aortic root was （59.97 ± 22.39） mmol/L, which was lower than that in University of Wisconsin solution. There was no significant difference in peak developed pressure or end diastolic pressure of left ventricle among the first 3 groups. Neither was cTnT concentration of the outflow reperfusion solution, but a significant reduction in pressure of left ventricle and significant increasing in cTnT concentration of outflow reperfusion solution in group 4 was noted when contrasted to the first 3 groups. There was no significant difference in myocardial tissue water content of 4 groups. Time related impairment to myocardia was seen by morphology and ultrastructure observation, with group 4, the most serious but reversible impairment. No focal myocardial necrosis was detected. Conclusions Non-beating hearts caused by injecting hyperkalemic solution via vein could be used as

关 键 词：心脏移植 供心 热缺血时间 高钾 心肌结构 

分 类 号：R654.2[医药卫生—外科学]