腺苷-利多卡因极化型心脏停搏液的心肌保护效果

摘要

目的 探讨腺苷-利多卡因极化型心脏停搏液在实验动物心内直视手术中的心肌保护作用.方法 12只纯种广两巴马小型猪被随机分为2组,每组6只,分别使用腺苷-利多卡因极化型停搏液和St.Thomas液间断顺行灌注进行对比.选取术前基础值、开放升主动脉后lh、2h3个时间点监测左心室收缩、舒张功能,心输出量与肌钙蛋白水平.术后采取左心室心尖部心肌标本做透射电镜下超微结构分析,并使用CMIAS彩色病理图像分析系统进行线粒体体视学分析.结果 两组术前基础值差异无统计学意义.术后两时间点腺苷-利多卡因停搏液组的左心室收缩末期压力、±dp/dt、心输出量数值均高于St.Thomas液组；左心室舒张末期压力、肺毛细血管楔压、血浆肌钙蛋白水平均低于St.Thomas液组,且腺苷-利多卡因组心脏复苏后的平均动脉压和心率波动范围更小,数据差异均具统计学意义(P＜0.05).超微结构提示St.Thomas液组较腺苷-利多卡因组心肌细胞损伤程度更严重.与术前基础值相比,St.Thomas液组线粒体形状因子显著降低,面密度与周密度显著增加,而腺苷-利多卡因组与术前相比变化不明显.结论腺苷-利多卡因冷晶体停搏液心脏停搏效果满意,心肌保护效果明显优于St.Thomas液.%Objective To determine whether polarized arrest using adenosine and lidocaine cold crystalloid cardioplegia would give satisfactory myocardial protection in the cardiac surgery of experimental animals.Methods Twelve pigs were randomized divided into 2 groups (n =6) to receive adenosine-lidocaine cardioplegia or St.Thomas cardioplegia.Left ventricular systolic and diastolic function,cardiac output,cardiac troponin 1 were monitored at before operation (T1),1 hour after crossclamp was removed (T2) and 2 hours after cross-clamp was removed (T3).After T3 the left ventricular ultrastructure was observed,mitochondrial ultrastructure was analyzed by CMIAS image system.Results There were no statistical differences between the two groups in T1.The left ventricular systolic pressure,± dp/dt and cardiac output in adenosine-lidocaine group wasmuch higher than St.Thomas group in T2 and T3,meanwhile the left ventricular diastolic pressure,capillary wedge pressureand cardiac troponin Ⅰ value was lower than St.Thomas group.The hemodynamic values was more stable in adenosine-lidocaine group.St.Thomas group got more myocardial injury alterations in intracellular structure than adenosine-lidocaine group.The image analysis of mitochondrial ultrastructure shows St.Thomas group got lower shape factor,higher area density and perimeter density compared with baseline and adenosine-lidocaine group values.Conclusion Adenosine-lidocaine cold crystalloid car-dioplegia gave satisfactory cardiac arrest,got better myocardial protection than St.Thomas cardioplegia.