常温不停跳保存供心的超微结构和动力学变化  

Myocardial ultrastructure and hemodynamic changes of donor heart preserved in normothemic beating status

作　　者：杨勇[1] 林辉[1,2] 温昭科[2] 黄爱兰[3] 温红[3] 黄国勇[3] 胡彦艳[3] 钟永泷[1] 

机构地区：[1]武汉大学人民医院心胸外科,湖北省武汉市430072 [2]广西壮族自治区人民医院心胸外科,广西壮族自治区南宁市530021 [3]广西壮族自治区人民医院麻醉科,广西壮族自治区南宁市530021

出　　处：《中国组织工程研究》2013年第5期851-858,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金委员会资助项目(81060027)~~

摘　　要：背景:心脏移植供心保护方法有向心脏正常生理状态改进的趋势,以期延长供心保存时间,改善供心的保存质量。理论上供心常温不停跳灌注保存是一种最接近生理状态的保存方法,有良好的发展潜力。目的:观察连续灌注不停跳供心常温长时间保存心肌超微结构和左室血流动力学的变化。方法:广西巴马小型猪24只,按随机数字表法分为不停跳连续灌注组和冷保存组,每组各6对。不停跳连续灌注组供心在顺行连续灌注跳动状态下切取,应用氧合血37℃、保存8h后移植。冷保存组供心应用UW停搏液灌停后,0-4℃UW液保存8h后移植。移植主动脉开放3h观察供心左心室收缩压、左心室舒张压、左室平均压、左室舒张末压、左室内压最大上升和下降速率。记录移植后心律变化,需要除颤例数,以及主动脉开放3h后能否脱离体外循环。主动脉开放3h后取供心左心室前外侧壁心肌组织,观察线粒体及肌膜改变。结果与结论:不停跳连续灌注组供心移植后左心室收缩压、左室平均压、左室舒张末压、左室内压最大上升和下降速率均优于冷保存组(P<0.05);主动脉开放后不停跳连续灌注组均可保持窦性心律,冷保存组仅1例自主恢复窦性心律;主动脉开放后3h不停跳连续灌注组5例可顺利脱机,冷保存组1例可以脱机;不停跳连续灌注组心肌超微结构保存良好。提示供心常温灌注不停跳方法有良好的心肌保护效果,适于供心的长期保存。BACKGROUND： For heart transplantation, the development trend of myocardial preservation method has changed from cold static storage to normal beating physiological status for prolonging preservation time and improving the quality of donor heart. Theoretically, the beating donor heart perfusion preservation at normal temperature is the preservation method that most close to the normal life state with a good potential for development. OBJECTIVE： To observe the changes of myocardial ultrastructure and left ventricular hemodynamics of beating donor heart with continuous blood perfusion at normal temperature. METHODS： Twenty-four Guangxi Bama miniature pigs were randomly divided into two groups： non-cardioplegia preservation group and cold preservation group, six pigs in each group. In the non-cardioplegia preservation group, the donor hearts were harvested in beating state and perfused continuously with normothermic oxygened blood. In the cold preservation group, the donor hearts were perfused with cold crystalliod cardioplegia for harvesting and persevered in 0-4 ℃ UW solution. After 8 hours, the donor hearts were transplanted to the recipients. After the transplanted aorta declamping for 3 hours, the left ventricular systolic pressure, left ventricular diastolic pressure, left ventricular mean pressure, left ventricular end-diastolic pressure, and the maximum rising and falling rate of left ventricular pressure of the donor hearts were observed. The changes of heart rhythm after transplantation, the number of required defibrillation and weaned from cardiopulmonary bypass after aortic declamping for 3 hours were recorded. The left ventricular anterolateral wall myocardial tissues of the donor hearts were obtained after aortic declamping for 3 hours to observe the changes of mitochondria and sarcolemma. RESULTS AND CONCLUSION： The left ventricular systolic pressure, left ventricular mean pressure, left ventricular end-diastolic pressure and the maximum rising and falling rate of left ventricular pressure

关 键 词：器官移植 心肺移植 心肌保护 连续灌注 心脏不停跳 冷保存 血流动力学 心肌超微结构 国家自然科学基金 器官移植图片文章 

分 类 号：R318[医药卫生—生物医学工程]