犬模拟临床心移植供心切取技术探讨  

A Study on the Method and Technique of Donor Heart Eviscerating in Orthotopic Transplantation of Canine

作　　者：吴兆红[1] 高锦平[1] 陈岗东[1] 王戈菲[1] 王武军[2] 杨锡耀[2] 

机构地区：[1]广州医学院附属市二人民医院心胸外科,广东广州510150 [2]第一军医大学附属南方医院心胸外科,广东广州510515

出　　处：《广州医学院学报》2003年第2期69-71,共3页Academic Journal of Guangzhou Medical College

摘　　要：目的:应用犬模拟临床同种异体原位标准式心脏移植,探讨供心切取的方法和技巧。方法:取杂种犬10只,体重在15-20 kg之间,雌雄不限。将其随机分为供心犬和受心犬两组。在热缺血时间为零的情况下,切取供心,进行相应的修剪和心肌保护,再将供心按标准术式移植入受心体内。待植入心脏复跳,循环稳定后脱离辅助循环,观察吻合口及早期心功能情况。结果:5次犬模拟临床原位同种异体标准术式心脏移植实验,供心植入受体内,2例植入心脏自动复跳,3例经1-4次电击除颤后恢复心跳,平均供心冷缺血时间130 min,供心吻合时间90 min。除1例左房顶部吻合口处漏血外,余吻合完好,5例均能在循环平稳的情况下脱离辅助循环,1例观察到实验犬清醒。结论:供心切取采取先灌后取,使热缺血时间为零,灌注时应注意灌注确切且防止灌注心脏过度膨胀。切取供心时从左向右,从下向上逆行切除更方便快捷,尽量保留更多血管组织便于修剪,在冷缺血期应使供心均衡受冷,若首次灌注不确切时可将心脏切取后经冠状动脉开口或冠状静脉窦继续灌注,确保心肌保护,减少心肌损伤。Objective: to explore the method and technique of eviscerating the donor heart by simulating the heart transplantation in dog according to clinical allogenic ih-situ standards. Method: Ten mongrel dogs weighting between 15 to 20 kg were divided into two groups, one as heart donors and the other as recipients. Eviscerate the heart from the donors with zero thermal ischemic time, manicure it and protect the myocardium, then transplant the heart into the recipient according to standard skills. Take off the assistant circulation after the embedded heart rebeats and the circulation leveled off, examine the inosculation and early cardiac function. Result: From 5 simulated experiments, the planted hearts rebeat autonomously in 2 cases, or rebeat after 1 to 4 times of tip-and-run defibrillation in 3 cases. The mean time of cold ischemia in donor hearts is 130 minutes; the time for donor heart inosculation is 90 minutes. All inosculation are in good condition except for leakage in one case at the top of left-atrium. Assistant circulation was withdrawn in all of the 5 cases when the circulation leveled off. In 1 case is observed that the tested dog regain consciousness. Conclusion: Perfuse and then take away the donor heart, and keep zero the time of thermal ischemia as well. Pay attention to the exact volume and prevent the heart from over-expanding while perusing. Cutting the donor heart should be begun from left to right, and from down to top, which would be more convenient and shortcut. Leave aside a little more vascular tissue for clipping as far as possible. During cold ischemia, the donor heart should be iced evenly. If the first perfusion was not precise enough, the heart may be cut open and perfused through the opening of coronary artery or sinus of coronary vein to ensure the myocardial preservation and decrease the injure 6f myocardium.

关 键 词：犬 供心 原位心移植 心肌保护 

分 类 号：R654.2[医药卫生—外科学]