顺/逆行同时心肌灌注对于细胞容量和能量代谢影响的研究  

Effects of Simultaneous Antegrade/Retrograde Cardioplegia on Cellular Volumes and Energy Metabolism

作　　者：李刚[1] 田伟忱[1] 及亚男[1] 李松梅[1] 蒋树林[1] TianGanghong 

机构地区：[1]哈尔滨医科大学附属第二医院心脏外科,黑龙江哈尔滨150086 [2]Institute for Biodiagnostics, National Research Council Canada, Winnipeg, Canada P3B1Y6

出　　处：《中国体外循环杂志》2007年第4期235-237,243,共4页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(30600158);黑龙江省自然科学基金(D200520)

摘　　要：目的应用磁共振图谱动态研究顺/逆行同时心肌灌注对于细胞容量和能量代谢的影响。方法由10个离体猪心的主动脉和冠状静脉窦同时灌注温血停跳液2小时期间,应用近红外线图谱动态监测心肌含水量的变化,并且联合使用磷31(31P)磁共振图谱和特异性细胞间隙标记物动态观察细胞内、外容量和心肌能量代谢的变化。结果近红外线图谱显示顺/逆行同时灌注期间的心肌含水量明显增高至其初始值的(160±12)%。水肿期间的31P磁共振图谱显示了顺/逆行同时灌注导致细胞内、外间隙标志物的含量均明显增高。通过计算可知,细胞内、外容量分别增长至其各自初始值的(136±4)%和(154±8)%。但是,顺/逆行同时灌注2小时期间的心肌能量代谢情况基本保持不变。结论2小时顺/逆行同时灌注导致细胞内、外容量均明显升高,但是水肿心肌在此期间能够维持正常能量代谢。OBJECTIVE To assess the effects of simultaneous antegrade/retrograde cardioplegia （SARC） on cellular volumes and energy metabolism using magnetic resonance spectroscopy. METHODS Ten isolated pig hearts were perfused for 2 hours through aorta and coronary sinus simultaneously with blood cardioplegia. Myocardial water content was monitored continuously throughout SARC using near infrared （NIR） spectroscopy. Phosphorus -31 magnetic resonance spectroscopy （31p MRS） in conjuction with n p MRS -detectable markers, dimethyl methylphosphonate （DMMP） and phenylpbospbonate （ PPA）, were used to follow the volumes of both intra - and extracellular compartments and to assess myocardial energy metabolism during SARC. DMMP distributes to the entire water space while PPA accesses only to the extra - cellular compartment. RESULTS NIR spectra showed a significant increase （ 160 ± 12% to the initial value 100% ） in water content during SARC, indicating tissue edema, 31p MR spectra obtained during SARC showed a gradual and significant increase in both DMMP and PPA peaks. At the end of 2 - hour SARC, the intra - and extra - cellular compartments increased to 136 ±4% and 154 ±8%, respectively, relative to their initial volumes （100%）. However, myocardial energy metabolites remained relatively unchanged during 2 - hour SARC. CONCLUSION 2 - hour SARC results in severe expansion of both intra - and extra - cellular compartments. Edematous myocardium can maintain normal energy metabolism during 2 - hour SARC.

关 键 词：磁共振 图谱 心肌灌注 心肌水肿 能量代谢 灌注 

分 类 号：R654.1[医药卫生—外科学]