温氧合血连灌与冷晶体液间灌心肌线粒体量化计分及形态改变的对比研究  

A comparative electron microscopic study of mitochondria structure and scoring of myocardium on continuous warm oxygenated blood perfusion and intermittent cold crystalloid perfusion

作　　者：庄世才[1] 法宪恩[1] 张大新[1] 冯德广[1] 张瑞成[1] 赵根尚[1] 

机构地区：[1]河南医科大学附属第二医院心外科

出　　处：《中华胸心血管外科杂志》1999年第4期206-209,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的：对温血连续灌注与冷晶体液间断灌注下心肌线粒体结构及量化计分进行了对比研究。方法：病人分两组（每组７例），主动脉阻断６０分钟后及再灌注２０分钟各取２ｍｍ直径心室壁肌肉置入４℃２．５％戊二醛液中固定２小时。在Ｈ６００型电镜下选择５个视野、每视野随机观察２０个线粒体。依受损程度分为０～４级（０级为正常结构，４级受损程度最重），将１００个线粒体按级得分总和除以１００即为该组得分数。结果：阻断６０分钟线粒体量化计分冷晶组为２．５１４３±０．２８６３，温血组计分为１．５４８６±０．０９１５（Ｐ＜０．００１）。再灌注２０分钟后冷晶组记分为３．０１４３±０．１７９２，温血组记分为１．６８２９±０．１５８１（Ｐ＜０．０１）。阻断６０分钟再灌２０分钟电镜下冷晶组线粒体嵴断裂、溶解、基质颗粒丢失明显、内外膜完整性消失；温血组线粒体嵴无断裂、外膜完整、基质颗粒略少。结论：电镜下线粒体超微结构及量化计分证明温血组心肌保护作用明显优于冷晶组。Aim:This study carried out to study the cardiac protection effect with the mitochondria structure and score between CWOBP and ICCP groups.Materials and methods:14 patients was divided into two groups(7 patients in each groups).After aorta was clamped over 60 minutes and 20 minutes after reperfusion,a piece of myocardium was obtained,and fixed in 2.5% distilled glutardehyde at 4℃ for 2 hours.They were observed under h 600 electron microscope.According to Flameng method,every mitochondria was graded on score 0 4 scale semiquantatively.Average score of 100 mitochondria per sample was calculated.Results:Mitochondria score of ICCP group was much higher than CWOBP group,(2.5143±0.2863 vs 1.5486±0.0915,P<0.001 after 60 minutes bypass, 3.0143 ±0.1792 vs 1.6829±0.1581 P<0.01 at 20 minutes after reperfusion).Crest disruption,membrane swelling were observed in ICCP group.Integrity of crest and normal mitochondria structure were found in CWOBP group.Conclusion:The results of this study indicate that continuous warm oxygenated blood cardioplegia is superior to intermittent cold crystalloid cardioplegia in myocardial pretection.

关 键 词：心肌线粒体 量化计分 停博液 冷晶体液 温氧合血 

分 类 号：R654.2[医药卫生—外科学]