血利鉀心停搏液和雙向灌注心肌保護(hù)的實(shí)驗(yàn)研究

1、血利鉀心停搏液和雙向灌注心肌保護(hù)的實(shí)驗(yàn)研究         07-11-16 14:51:00     作者：     編輯：studa20                  作者：章曉華， 張鏡方， 吳若彬， 肖學(xué)鈞， 陳萍【關(guān)鍵詞】  心停搏液 

2、   摘要：目的通過(guò)與三種經(jīng)典心肌保護(hù)方法比較，探討含血利多卡因高鉀(血利鉀)心停搏液和雙向灌注心肌保護(hù)法的心肌保護(hù)作用。方法犬20只，隨機(jī)分成四組(n=5)，分別用晶體心停搏液(CG1)、冷稀釋血心停搏液(CG2)、常溫稀釋血心停搏液(CG3)及血利鉀心停搏液(EG)。每組均經(jīng)歷120min心臟缺血。觀察心臟停搏情況、冠狀靜脈竇回流血量及心肌酶濃度、心肌細(xì)胞內(nèi)鈣離子(Ca2+)和丙二醛(MDA)及三磷酸腺苷(ATP)含量、心肌形態(tài)學(xué)改變。結(jié)果 實(shí)驗(yàn)組(EG)心臟停搏時(shí)間短，心停搏液用量少，冠狀靜脈血流量及心肌氧攝取率在缺血前后無(wú)明顯變化；血清心肌酶水平各組間無(wú)顯著差異；E

3、G再灌注心肌Ca2+超負(fù)荷及ATP含量下降較CG3明顯，與CG2相似；EG再灌注心肌MDA水平較CG1顯著降低。心肌形態(tài)學(xué)改變各組間無(wú)顯著差異。結(jié)論血利鉀心停搏液和雙向灌注具有確切的心肌保護(hù)作用。關(guān)鍵詞：缺血-再灌注損傷；心停搏液；心肌保護(hù)；體外循環(huán)Cardioprotective Effects of Lidocaine-Hyperpotassium-Blood Cardioplegic Solution with Combined Delivery Routeson Ischemia-Reperfusion Injury in Canine HeartsAbstract: OBJECTIV

4、E  To investigate the myocardial protective effects of lidocaine-hyperpotassium-blood cardioplegic solution with combined delivery routes by comparing to three most widely used strategies of myocardial protection.METHODS  20 adult canines were placed on cardiopulmonary bypass (CPB) and ran

5、domized to receive four myocardial protective protocols respectively (5 in each group): cold supplementing St. Thomas Hospital crystalloid solution cardioplegia antegradely and intermittently (CG1), hypothermic blood cardioplegia antegradely and intermittently (CG2), warm blood cardioplegia antegrad

6、ely and continuously (CG3), and lidocaine-hyperpotassium-blood cardioplegia with combined  routes(EG). Each group underwent CPB and was submitted to 120 minutes of myocardial ischemia and a 30 minutes period of reperfusion. Arrest of the heart and coronary venous sinus flowrate were recorded. S

7、erum cardiac enzymes and myocardial intracellular malondiadehyde (MDA), ion calcium (Ca2+), adenosine triphosphate (ATP) were measured. Myocardial structure changes after ischemia and reperfusion were observed with optical and electronic microscope.RESULTS  Lidocaine-hyperpotassium-blood cardio

8、plegic solution with combined delivery routes shortened the time of arrest of the heart, and decreased the volume of cystalloid cardioplegic solution used. There was no significant difference in coronary sinus blood flowrate (CSF) and myocardial retrieval oxygen (MRO) between post- and pre- ischemia

9、 in all groups. There was no significant difference in increase of serum cardiac enzymes after ischemia comparing EG with control groups. Myocardial intracellular Ca2+ overload and exhaustion of ATP during reperfusion in EG were obvious comparing to CG3, and similar to CG2. The level of myocardial i

10、ntracelluar MDA after 30 minutes reperfusion in EG was significantly lower comparing to CG1. No significant difference in structural changes were detected between the groups.  CONCLUSION Comparing with other classical techniques, cardioplegia with lidocaine-hyperpotassium-blood cardioplegicsolu

11、tion and combined delivery routes represents a simple, safe and effective method of myocardial protection which may be an alternative to traditional cardioprotective techniques. Key words：ischemia-reperfusion injury; cardioplegic solution; myocardial protection; cardiopulmonary bypass  

12、60;                                                 

13、60;               心停搏液的成分、灌注方式及不同心肌保護(hù)方法的選用等仍存在爭(zhēng)議1-3。含血利多卡因高鉀心停搏液(簡(jiǎn)稱血利鉀心停搏液)及雙向性灌注心肌保護(hù)法采用高濃度鉀離子(K+)和利多卡因的含血心停搏液進(jìn)行心臟的誘導(dǎo)灌注，用冷晶體心停搏液進(jìn)行冠狀靜脈竇持續(xù)微流量逆行灌注。本研究旨在通過(guò)動(dòng)物實(shí)驗(yàn)將血利鉀心停搏液及雙向性灌注心肌保護(hù)法與三種經(jīng)典的心停搏液灌注方法進(jìn)行比較，以探討新的心肌保護(hù)措施。1 材料與方法  1.1 實(shí)驗(yàn)動(dòng)物及分

14、組                                  雜種犬20只，均為雄性，平均體重(21.3±2.0)kg，各組間平均體重?zé)o顯著性差異。將實(shí)驗(yàn)動(dòng)物隨機(jī)分成四組(n=5)。分別使用改良St. Thomas醫(yī)院冷晶體心停搏液間斷順行灌注(CG1

15、)、冷稀釋血心停搏液間斷順行灌注(CG2)、常溫稀釋血心停搏液連續(xù)順行灌注(CG3)、及血利鉀心停搏液雙向性灌注(EG)。各種晶體心停搏液配方見(jiàn)表1。除CG3心停搏液不進(jìn)行降溫外，晶體心停搏液降至68，含血心停搏液降至1012。表1 晶體心停搏液配方（略）注：晶體心停搏液按1：4與血液混合后的K+濃度，：晶體心停搏液與60mL血液混合后的K+濃度。1.2 實(shí)驗(yàn)方法                   

16、60;              實(shí)驗(yàn)犬麻醉后行氣管插管，接呼吸機(jī)和心電監(jiān)護(hù)儀，置左側(cè)股動(dòng)、靜脈導(dǎo)管測(cè)壓及鼻咽溫度探頭。正中切口開(kāi)胸，全身肝素化后經(jīng)右股動(dòng)脈和上、下腔靜脈插管建立體外循環(huán)(CPB)。開(kāi)始CPB后經(jīng)右房置入冠狀靜脈竇逆灌管，降溫至近25時(shí)(CG3不進(jìn)行血流降溫)阻斷升主動(dòng)脈，灌注心停搏液。CG1、CG2、CG3使用高濃度心停搏液15mL/kg經(jīng)主動(dòng)脈根部用CPB血泵灌注；EG用血利鉀心停搏液68.5mL通過(guò)注射器快速注入主動(dòng)脈根部。同時(shí)心包腔內(nèi)置冰屑(

17、CG3除外)。CG1和CG2分別每隔30分和20分灌注誘導(dǎo)量半量的低濃度心停搏液；CG3用50mL/min低濃度溫血心停搏液持續(xù)經(jīng)升主動(dòng)脈根部灌注；EG在誘導(dǎo)灌注后用高濃度改良St. Thomas晶體心停搏液經(jīng)冠狀靜脈竇通過(guò)重力(壓力落差60cm)以3mL/min的速度逆行灌注。升主動(dòng)脈阻斷120分后開(kāi)放阻斷鉗，輔助30分后終止CPB。主要觀察指標(biāo)包括：心停搏液灌注和心電活動(dòng)情況；冠狀靜脈竇回流血流量、血?dú)夥治黾捌湫募∶杆?；心肌?xì)胞內(nèi)鈣離子(Ca2)、丙二醛(MDA)、三磷酸腺苷(ATP)含量；心肌組織光鏡及電鏡形態(tài)學(xué)。實(shí)驗(yàn)數(shù)據(jù)使用SPSS進(jìn)行統(tǒng)計(jì)學(xué)處理，以P<0.05表示有統(tǒng)計(jì)學(xué)顯著

18、差異。2  結(jié)果2.1 心臟停搏及復(fù)跳情況                                  各組動(dòng)物心臟均能順利停搏，復(fù)灌后均無(wú)需電除顫復(fù)律。心臟停搏及復(fù)跳情況見(jiàn)表2。表2 心臟停搏及復(fù)跳情況（略） 注：與EG相比*P<0.05，* P<0.01，#復(fù)灌時(shí)CG2有1例在心臟血流阻斷期間出現(xiàn)室顫；CG3有2例在心臟停搏早期出現(xiàn)心臟復(fù)跳現(xiàn)象，需再次用高濃度心停搏液誘導(dǎo)灌注及增加維持灌注量。CG2、EG各有1例和CG1有2