顺行灌注心脏不停跳法的心肌保护作用  

Experimental study of myocardial protection with antegrade perfusion in beating heart

作　　者：林辉[1] 高尚志[2] 李欣[3] 李香伟[1] 温绍科[1] 莫安胜[1] 

机构地区：[1]广西壮族自治区人民医院胸心外科,南宁530021 [2]武汉大学人民医院胸心外科 [3]上海胸科医院体外循环室

出　　处：《中华实验外科杂志》2003年第10期910-911,共2页Chinese Journal of Experimental Surgery

基　　金：广西 2 0 0 1年"新世纪十百千人才工程"资助项目(2 0 0 1 2 0 3)

摘　　要：目的　探讨顺行灌注心脏不停跳法心肌保护作用的效果。方法　选用 12～ 16周龄健康长耳白兔 3 0只 ,随机分为 3组 ,每组 10只。A组 (心脏不停跳组 ) :经主动脉持续灌流 3 2℃稀释血液 15 0min。B组 (冷血钾心脏停跳组 ) :在主动脉间断灌注 15℃血钾心停搏液 5 0ml ,将心脏置入 15℃生理盐水中 15 0min。C组 (微温血连续灌注心脏停跳组 ) :从主动脉持续灌注 3 2℃血钾心停搏液 15 0min。观察心功能、心肌酶、左心室心肌生化、氧自由基。结果　A组主动脉流量 (AF)、冠脉流量 (CF)、左室收缩压 (LVSP)和舒张末压 (LVEDP)的恢复率较B组和C组好 ,心肌组织三磷酸腺苷 (ATP)含量为 [(12 .17± 0 .69) μmol/g干重 ]、超氧化物歧化酶 (SOD)活性均高于B组 [ATP(8.5 2± 1.0 4) μmol/ g干重 ]和C组 [ATP (9.0 5± 1.0 4) μmol/ g干重 ] ,丙二醛 (MDA)、Na+ 、Ca2 +含量、冠脉流出液的乳酸盐 (LA)、心肌肌酸磷酸激酶 (CPK )和乳酸脱氢酶 (LDH)漏出率比B组和C组低 (P <0 .0 1) ;B组与C组比较 ,差异无显著性 (P >0 .0 5 )。结论　顺行灌注心脏不停跳法有良好的心肌保护作用 ,是一种安全。Objective To evaluate the myocardial protective effects of antegrade perfusion in beating heart.Methods Isolated rat working heart models were used.Forty rats of 3～4 months were randomly divided into 3 groups:group A (beating heart, n =10),group B (cold blood cardioplegia arrest at 15 ℃, n =10),group C (continuous warm blood cardioplegia arrest, n =10).Cardiac functional recovery,changes of myocardial biochemistry of left ventricle,LDH and CPK leakage and free radical were assessed 150 min after perfusion.Results Cardiac functional recovery were better,ATP content and superoxide dismutase (SOD) activity higher in group A [ATP (12.17±0.69) μmol/gdw] than in group B (8.52±1.04) μmol/gdw and group C (9.05±1.04) μmol/gdw.However,the levels of malondialdehyde (MDA),LA,Na + and Ca 2+ contents and LDH and CPK leakage were lower significantly in group A than in group B and group C ( P <0.05).Conclusion Antegrade perfusion in beating heart has a good effect on myocardial protection and is a safe myocardial protective way more closing to the physiologic state.

关 键 词：心脏不停跳法 顺行灌注 心肌保护作用 主动脉持续灌流 

分 类 号：R654.2[医药卫生—外科学]