McCully J D, Uematsu M, Levitsky S
Division of Cardiothoracic Surgery and Biometrics Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 1999 Mar;67(3):699-704. doi: 10.1016/s0003-4975(98)01371-x.
We recently described a novel myoprotective protocol-adenosine-enhanced ischemic preconditioning (APC)-that extends the protection of ischemic preconditioning (IPC) by both reducing myocardial infarct size and enhancing postischemic functional recovery in the isolated perfused heart. In the present report the efficacy of APC in the blood-perfused heart was investigated and compared with that of cold blood cardioplegia (CBC).
Cardiopulmonary bypass was instituted in 21 sheep hearts. The APC hearts (n = 6) received a bolus injection of adenosine through the aortic root at the immediate start of IPC (5 minutes of zero-flow global ischemia, followed by 5 minutes of reperfusion) before 30 minutes of global ischemia and 120 minutes of reperfusion. Nine other hearts received CBC. A control group (n = 6) received IPC only.
Infarct size was significantly decreased (p<0.01) in the APC (3.0%+/-0.8%) and CBC (2.6%+/-0.2%) hearts compared with the IPC hearts (16.3%+/-1.6%). The preload recruitable stroke work relation, mean arterial pressure, and the time constant of pressure decay (tau) were significantly preserved (p<0.05) in APC and CBC hearts compared with IPC hearts. No significant differences were observed between APC and CBC hearts.
Use of APC is as effective as CBC in significantly decreasing infarct size and enhancing post-ischemic functional recovery.
我们最近描述了一种新型的心肌保护方案——腺苷增强缺血预处理（APC），该方案通过减小心肌梗死面积和增强离体灌注心脏缺血后的功能恢复来延长缺血预处理（IPC）的保护作用。在本报告中，研究了APC在血液灌注心脏中的疗效，并与冷血心脏停搏液（CBC）进行了比较。
对21只羊心脏进行体外循环。APC组心脏（n = 6）在30分钟全心缺血和120分钟再灌注前，在IPC开始时（5分钟零流量全心缺血，随后5分钟再灌注）通过主动脉根部给予腺苷推注。另外9只心脏接受CBC。对照组（n = 6）仅接受IPC。
与IPC组心脏（16.3%±1.6%）相比，APC组（3.0%±0.8%）和CBC组（2.6%±0.2%）心脏的梗死面积显著减小（p<0.01）。与IPC组心脏相比，APC组和CBC组心脏的可募集前负荷每搏功关系、平均动脉压和压力衰减时间常数（tau）得到显著保留（p<0.05）。APC组和CBC组心脏之间未观察到显著差异。
使用APC在显著减小梗死面积和增强缺血后功能恢复方面与CBC同样有效。
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