温血心停跳液持续灌注对心内直视术中犬心肌细胞质膜的保护作用  

Protective effects of continuous warm blood cardioplegia on cardiomyocyte sarcolemma of canine heart during open heart surgery.

作　　者：陈伟民[1,2,3] 朱洪生[1,2,3] 黄日太[1,2,3] 韩玉升 易静 卢蓉[1,2,3] 钱伟民 张有荣[1,2,3] 吴学军[1,2,3] 

机构地区：[1]上海第二医科大学附属仁济医院心胸外科 [2]广州市胸科医院胸外科 [3]上海第二医科大学电镜室

出　　处：《中华实验外科杂志》1999年第4期352-353,共2页Chinese Journal of Experimental Surgery

摘　　要：目的观察温血心停跳液持续灌注对心内直视术中犬心肌细胞质膜的保护作用。方法采用温血心停跳液持续灌注（ＣＷＢＣ）或冷晶体心停跳液间断灌注（ＩＣＣＣ）作心肌保护。以镧（Ｌａ３＋）标记电镜技术观察心肌细胞质膜通透性的改变。结果主动脉阻断前，两组心肌组织中Ｌａ３＋局限在心肌细胞外间隙沉积；再灌注后６０分钟，对照组心肌细胞线粒体内、周边及肌原纤维上有Ｌａ３＋沉积，实验组心肌细胞内无Ｌａ３＋沉积。结论①Ｉ／Ｒ损伤后早期，心肌细胞质膜通透性增高；②ＣＷＢＣ可以减轻心肌损伤，很好地维持心肌细胞质膜的完整性。Objective To eveluate the protective effects of continuous warm blood cardioplegia on cardiomyocyte sarcolemma during the open heart surgery.Methods A global myocardial ischemia/reperfusion (I/R) animal model was established by aortic crossclamping in canine for 60 min, followed by release of crossclamping and reperfusion for 60 min. During the ischemic period, continuous warm blood cardioplegia. CWBC (experiment group, n =4) or intermittent cold crystalloid cardioplegia (ICCC) (control group, N =4) were applied. Tissues from left ventricle were evaluated for sarcolemmal permeability as determined by ionic lanthanum (La 3+ ) probe technique and electron microscopy. Results Before aortic crossclamping, cardiomyocytes from both groups were normal with La 3+ localized exclusively in the extracellular space. After reperfusion for 60 minutes, myocytes in control group showed injury changes with particulate deposits of La 3+ in or adjacent to mitochondria and myofibril. Whereas myocytes in experiment group were well preserved with no particulate deposits of La 3+ in the cells. Conclusions ① cardiomyocyte sarcolemma permeability increase during the early stage of myocardial injury due to I/R; ② CWBC, could decrease the myocardial injury and maintain excellently cardiomyocyte sarcolemma integrity during the open heart.

关 键 词：温血心停跳液 持续灌注 心内直视术 心肌细胞 

分 类 号：R654.2[医药卫生—外科学]