Karck M, Vivi A, Tassini M, Schwalb H, Askenasy N, Navon G, Borman J B, Uretzky G
Joseph Lunenfeld Cardiac Surgery Research Center, Hadassah University Hospital, Jerusalem, Israel.
J Thorac Cardiovasc Surg. 1992 Nov;104(5):1356-64.
The effectiveness of the University of Wisconsin solution on extended myocardial preservation was examined in this study using phosphorus 31-nuclear magnetic resonance spectroscopy. Isolated perfused rat hearts were arrested and stored in four preservation solutions: group 1, modified Krebs-Henseleit solution; group 2, modified St. Thomas' Hospital solution; group 3, oxygenated modified St. Thomas' Hospital solution containing 11 mmol/L glucose; and group 4, University of Wisconsin solution. The changes in myocardial high energy phosphate profiles and the intracellular pH values were measured during 12 hours of cold (4 degrees C) global ischemia and 90 minutes of normothermic reperfusion. Following ischemia, the hearts were assessed for hemodynamic recovery and myocardial water content. During ischemia, adenosine triphosphate depletion was observed in all groups; however, after 5 hours of ischemia, the adenosine triphosphate levels were significantly higher in group 3 compared with the other groups (adenosine triphosphate levels at 6 hours in mumol/gm dry weight: group 3, 7.6; group 4, 3.2; group 2, < 1; p < 0.025). The tissue water content at the end of ischemia was lower with the University of Wisconsin solution compared with the modified St. Thomas' Hospital solution or the oxygenated modified St. Thomas' Hospital solution (in ml/gm dry weight: group 4, 3.0; group 2, 4.4; group 3, 3.9; p < 0.05). The adenosine triphosphate repletion during reperfusion was greater with the University of Wisconsin solution compared with the modified St. Thomas' Hospital solution or the oxygenated modified St. Thomas' Hospital solution (12 mumol/gm dry weight in group 4; 8.1 in group 2; 9.0 in group 3; p < 0.05). Similar findings were obtained for the recovery of left ventricular pressure (in percent of preischemic control: group 4, 70%; group 2, 42%; group 3, 52%; p < 0.01) and coronary flow (group 4, 61%; group 2, 49%; group 3, 49%; p < 0.05). These data suggest that preservation with the University of Wisconsin solution affords improved hemodynamic recovery, enhanced adenosine triphosphate repletion, and reduced tissue edema upon reperfusion; however, oxygenated St. Thomas' Hospital solution with glucose is associated with the preservation of higher myocardial adenosine triphosphate levels during prolonged cold global ischemia. In conclusion, these data indicate that the University of Wisconsin solution might improve graft tolerance of ischemia in clinical heart transplantation.
本研究采用磷31核磁共振波谱法检测威斯康星大学溶液在延长心肌保存方面的有效性。将离体灌注的大鼠心脏停搏并储存在四种保存溶液中：第1组，改良的克雷布斯 - 亨斯莱特溶液；第2组，改良的圣托马斯医院溶液；第3组，含11 mmol/L葡萄糖的氧合改良圣托马斯医院溶液；第4组，威斯康星大学溶液。在4℃冷缺血12小时和常温再灌注90分钟期间，测量心肌高能磷酸盐谱和细胞内pH值的变化。缺血后，评估心脏的血流动力学恢复情况和心肌含水量。在缺血期间，所有组均观察到三磷酸腺苷耗竭；然而，缺血5小时后，第3组的三磷酸腺苷水平显著高于其他组（6小时时三磷酸腺苷水平，μmol/g干重：第3组，7.6；第4组，3.2；第2组，<1；p<0.025）。与改良的圣托马斯医院溶液或氧合改良圣托马斯医院溶液相比，威斯康星大学溶液组在缺血末期的组织含水量更低（ml/g干重：第4组，3.0；第2组，4.4；第3组，3.9；p<0.05）。与改良的圣托马斯医院溶液或氧合改良圣托马斯医院溶液相比，威斯康星大学溶液组在再灌注期间三磷酸腺苷的补充更多（第4组为12 μmol/g干重；第2组为8.1；第3组为9.0；p<0.05）。在左心室压力恢复（缺血前对照的百分比：第4组，70%；第2组，42%；第3组，52%；p<0.01）和冠状动脉血流恢复（第4组，61%；第2组，49%；第3组，49%；p<0.05）方面也获得了类似的结果。这些数据表明，用威斯康星大学溶液保存可改善血流动力学恢复、增强三磷酸腺苷补充并减少再灌注时的组织水肿；然而，含葡萄糖的氧合圣托马斯医院溶液在长时间冷缺血期间可使心肌三磷酸腺苷水平保持较高。总之，这些数据表明威斯康星大学溶液可能会提高临床心脏移植中移植物对缺血的耐受性。
