终末热灌注对心脏移植术中猪供体心脏的保护作用

摘要

Aim:To investigate the effect of the terminal warm cardioplegia perfusion ( TWCP ) in pig′s donor hearts undergoing heart transplant .Methods:A total of 24 Swedish domestic pigs were randomly allocated into two groups: the control group and the TWCP group with 12 in each group .In the control group the cross clamp was released immediately af-ter the completion of heart transplant .In the TWCP group the donor hearts were perfused with warm cardioplegia for 2 min prior to removal of the cross clamp .Blood samples were collected from coronary sinus and aortic root before placed the cross clamp.The quantification of lactate and oxygen saturation , and the blood flow in the coronary artery were monitored before reperfusion and at 5 min,30 min,1 h and 2 h after reperfusion.Myocardial troponin T in the blood samples of the internal jugular vein was determined after releasing the cross clamp , and at 4,12,and 24 h after reperfusion.Results:The results showed no significant difference in blood flow of the coronary artery between the two groups (Fgroup =2.193,P=0.173). There were significant differences in lactate accumulation and myocardial troponin T concentration after surgery ( Ftime =44.844 and 138.908);compared with control group , the oxygen utilization of the TWCP group recovered earlier , the lac-tate accumulation of the TWCP group was reduced , and the myocardial troponin T concentration in the TWCP group was re-duced after 24 h reperfusion(P<0.05).Conclusion: In heart transplant, TWCP reduces myocardial anaerobic metabo-lism, promotes myocardial functional recovery and reduces myocardial injury .%目的：观察终末热灌注对心脏移植术中猪供体心脏的保护作用。方法：12对配型成功的同家系瑞典猪随机分为实验组与对照组，每组6对，分别行心脏移植术。对照组手术完成后正常放开主动脉钳恢复心脏灌注，实验组则在开放主动脉前经历短暂的终末热灌注再恢复灌注。分别于供体心脏缺血前，恢复灌注5 min、30 min、1 h及2h取冠状窦口和主动脉根部血样，监测冠状动脉血流量，记录血样中氧分压及乳酸含量；在恢复灌注时及恢复灌注4、12、24 h分别抽取猪颈内静脉血样检测肌钙蛋白T。结果：2组恢复灌注后冠状动脉血流量间差异无统计学意义（F组间＝2．193，P＝0．173）。2组心脏氧利用率，不同时间点间心肌乳酸利用量及血浆肌钙蛋白T浓度差异有统计学意义（F组间＝9．041、F时间＝44．844和138．908，P＜0．05）；实验组心脏氧利用率更早恢复正常，在恢复灌注5 min，实验组心肌乳酸利用量低于对照组，在恢复灌注24 h，实验组血浆肌钙蛋白T浓度低于对照组（P＜0．05）。结论：心脏移植术中终末热灌注可降低心脏无氧代谢水平，促进心肌细胞功能恢复，减轻心肌损伤。