Ko W, Zelano J A, Lazzaro R, Lazenby W D, Hamilton T, Isom O W, Krieger K H
Cardiothoracic Surgery Research Laboratory, New York Hospital-Cornell University Medical College, N.Y. 10021.
J Thorac Cardiovasc Surg. 1992 May;103(5):980-92.
To compare the effects of the University of Wisconsin solution with those of an extracellular crystalloid solution, Krebs-Ringer bicarbonate, as cardiac preservation media, we studied 35 adult dogs in an isolated heart preparation. Four groups of seven hearts were preserved in University of Wisconsin solution for 6 or 12 hours or in Krebs-Ringer bicarbonate solution for 6 or 12 hours. An additional group of seven hearts with no ischemia was used for a control group. In the four preservation groups, hearts were arrested by electrolyte solution (Normosol with potassium chloride, 20 mEq/L, added, 4 degrees C), flushed with 200 ml of the preservation solution, and then stored in the same solution at 1 degree to 2 degrees C. The hearts were mounted on an isolated heart preparation equipped with a computer-controlled servo-pump system that used a mock arterial system to modulate the aortic input impedance presented to the left ventricle. Left ventricular pressure-volume loops were measured on-line for 2 hours of reperfusion with autologous warm oxygenated blood. Elastance was derived from the end-systolic pressure-volume relationship, and diastolic compliance was derived from the end-diastolic pressure-volume relationship. The total left ventricular performance was assessed by the preload recruitable stroke work area, the slope, and its x-intercept, all of which derived from the stroke work (pressure-volume area)-end-diastolic volume relationship. Extended global ischemia had more deleterious effects on the end-diastolic than the end-systolic pressure-volume relationship. In confirmation with other studies, elastance did not accurately reflect the level of ventricular contractile dysfunction because of the significant amount of diastolic dysfunction. The preservation of myocardial systolic and diastolic functions, as demonstrated by the preload recruitable stroke work area and diastolic compliance, was better in the University of Wisconsin solution groups than in the Krebs-Ringer bicarbonate solution groups after 6 and 12 hours of preservation. In addition, 6 hours of preservation with University of Wisconsin solution maintained normal systolic and diastolic functions as compared with those of the control group. Preservation with University of Wisconsin solution prevented any myocardial edema formation; by contrast, this was significantly increased after 12 hours in Krebs-Ringer bicarbonate solution. Groups preserved with University of Wisconsin solution had less reperfusion injury as evidenced by the release of coronary sinus creatine kinase during reperfusion; they also had improved oxygen use during reperfusion.(ABSTRACT TRUNCATED AT 400 WORDS)
为比较威斯康星大学溶液与细胞外晶体溶液（ Krebs-Ringer 碳酸氢盐溶液）作为心脏保存介质的效果，我们在离体心脏制备实验中研究了 35 只成年犬。将七组心脏分为四组，分别用威斯康星大学溶液保存 6 小时或 12 小时，或用 Krebs-Ringer 碳酸氢盐溶液保存 6 小时或 12 小时。另外选取七组未经历缺血的心脏作为对照组。在四个保存组中，心脏先用含氯化钾（20 mEq/L）的电解质溶液（Normosol）在 4℃时停搏，再用 200 ml 保存液冲洗，然后在 1℃至 2℃下保存在相同溶液中。将心脏安装在配备计算机控制伺服泵系统的离体心脏制备装置上，该系统使用模拟动脉系统调节左心室的主动脉输入阻抗。用自体温氧合血进行 2 小时再灌注期间在线测量左心室压力 - 容积环。弹性模量由收缩末期压力 - 容积关系得出，舒张顺应性由舒张末期压力 - 容积关系得出。左心室整体功能通过可募集的前负荷搏功面积、斜率及其 x 截距进行评估，所有这些均源自搏功（压力 - 容积面积）与舒张末期容积关系。长时间的全心缺血对舒张末期压力 - 容积关系的有害影响比对收缩末期压力 - 容积关系的影响更大。与其他研究一致，由于存在明显的舒张功能障碍，弹性模量不能准确反映心室收缩功能障碍的程度。在保存 6 小时和 12 小时后，威斯康星大学溶液组中通过可募集的前负荷搏功面积和舒张顺应性所显示的心肌收缩和舒张功能的保存情况优于 Krebs-Ringer 碳酸氢盐溶液组。此外，与对照组相比，用威斯康星大学溶液保存 6 小时可维持正常的收缩和舒张功能。用威斯康星大学溶液保存可防止任何心肌水肿形成；相比之下，在 Krebs-Ringer 碳酸氢盐溶液中保存 12 小时后心肌水肿明显增加。威斯康星大学溶液保存组的再灌注损伤较小，这在再灌注期间冠状窦肌酸激酶的释放中得到证明；它们在再灌注期间的氧利用也有所改善。（摘要截选至 400 字）
