不同种类心脏停搏液对心肌线粒体及三磷酸腺苷的影响  

Effects of different cardioplegia to the mitochondrial ultrastructure parameters and concentration of adenosine triphosphate in myocardium

作　　者：孟保英[1] 张青[1] 王敬华[1] 丁以群[1] 潘晓兰[1] 王元祥[1] 吴文智 MENG Bao-ying;ZHANG Qing;WANG Jing-hua;DING Yi-qun;PAN Xiao-lan;WANG Yuan-xiang;WU Wen-zhi(Cardiovascular Surgery Center,Shenzhen Children′s Hospital,Shenzhen,Guangdong 518026,China)

机构地区：[1]深圳市儿童医院心胸外科,深圳518026

出　　处：《岭南心血管病杂志》2018年第1期78-82,共5页South China Journal of Cardiovascular Diseases

基　　金：深圳市科技计划资助项目(项目编号:JCYJ20150403100317074)

摘　　要：目的探讨含不同比例自体血冷心脏停搏液对体外循环下未成熟心肌线粒体超微结构及三磷酸腺苷(adenosine triphosphate,ATP)浓度的影响。方法选择年龄≤1岁,体质量≤10 kg,体外循环心脏直视手术患儿240例,随机分成HTK液灌注组(A组,n=20)、改良ST.Tomas液灌注组(B组,n=55),4:1含自体血停搏液组(C组,n=55),1∶1含自体血停搏液组(D组,n=55),1∶4含自体血停搏液组(E组,n=55),体外循环开始前5 min和主动脉开放后5 min分别取右心房心肌组织标本,透视电镜观察心肌线粒体超微结构改变,用高效液相色谱法(high performance liquid chromatography,HPLC)法测定心肌ATP浓度。结果 A组和E组心肌线粒体损伤程度低于B、C、D组,而心肌细胞ATP含量明显高于B、C、D组(P<0.05);E组心肌线粒损伤程度高于A组,心肌细胞ATP浓度低于A(P<0.05)。结论 HTK液及1∶4含自体血心脏停搏液对体外循环心脏直视手术未成熟心肌保护作用优于其他心脏停搏液。Objectives To observe the effects of cold cardioplegia with different ratio of autologous blood to the mitochondrial ultrastructure parameters and concentration of adenosine triphosphate(ATP)in immature cardiocyte after opening cardiac operation by cardiopulmonary bypass(CPB).Methods Totally240infantile patients with congenital heart disease underwent operation by CPB were randomized divided into5groups according to the different cardioplegia solution:HTK solution group(n=20,A group);ST.Thomas solution group(n=55,B group);cold blood cardioplegia with ratio4∶1(n=55,C group);cold blood cardioplegia with ratio1∶1(n=55,D group);cold blood cardioplegia with ratio1∶4(n=55,E group).The heart tissue of right atrial was collected5minutes before CPB and5minutes after aortic declamping.Heart tissue was withdrawn for homogenate.Concentration of ATP in heart tissue was determined by high performance liquid chromatography(HPLC).Results Degrees of mitochondrial damage in A,E groups significantly decreased than those in B,C and D groups(P<0.05);Degree of mitochondrial damage in E group significantly increased than in A group(P<0.05).Concentrations of ATP in A,E group were significantly higher than those of B、C、D groups(P<0.05).Concentrations of ATP in A group was significantly higher than that of E group(P<0.05).Conclusions HTK and cold self-blood cardioplegia with ratio1∶4were useful to the immature myocardial profection underwent opening cardiac operation by CPB in infant.

关 键 词：心脏缺损 先天性 心脏停搏液 线粒体 三磷酸腺苷 心肌 

分 类 号：R541.7[医药卫生—心血管疾病]