Gott J P, Brown W M, Dorsey L M, Walker B, Guyton R A
Carlyle Fraser Heart Center, Crawford Long Hospital, Emory University, Atlanta, Ga.
J Heart Lung Transplant. 1992 Mar-Apr;11(2 Pt 1):353-61; discussion 362.
Clinical practice and laboratory studies have demonstrated the efficacy of cold crystalloid cardioplegia for donor heart protection. Efforts to increase the margin of safety for protection led us to compare unmodified University of Wisconsin (UW) solution to the dextrose, mannitol-based Stanford (ST) solution. A canine model of heart transplantation with antegrade hypothermic cardioplegic arrest and 6 hours of 4 degrees C ischemic storage was used. An oxygenated blood-primed isolated heart preparation was used for reperfusion and myocardial mechanics and energetics studies of the working heart. Six of 6 UW and 4 of 6 ST hearts reached the working phase. Computer-assisted analysis of pressure-volume loops generated at varying flows measured by tri-axial sonomicrometry and high-fidelity micromanometry showed no significant differences in function between the ST and UW groups by maximum elastance (UW, 4.2 +/- 1.1; ST, 4.0 +/- 0.7), preload recruitable stroke work (UW, 43.7 +/- 7.3; ST, 43.4 +/- 8.7), or slope of log-linear end-diastolic pressure-volume curve (UW, 0.057 +/- 0.01, ST, 0.061 +/- 0.01). Specimens for determination of myocardial water content were taken after cardioplegic arrest, after storage, after reperfusion, and after the working phase. There was a significant increase in tissue water after reperfusion in both groups (UW, 75.7% +/- 0.5% to 81.6% +/- 0.2%, p = 0.0001; ST, 76.5% +/- 0.4% to 83.4% +/- 0.3%, p = 0.0002), which persisted after the working phase (UW, 81.5% +/- 0.9%, p = 0.0002; ST, 82.6% +/- 0.1%, p = 0.0003). Both groups exhibited postreperfusion increase in myocardial water content, but this edema was significantly less marked in the UW group (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
临床实践和实验室研究已证明冷晶体心脏停搏液对供心保护的有效性。为提高保护的安全边际，我们将未改良的威斯康星大学（UW）溶液与基于葡萄糖、甘露醇的斯坦福（ST）溶液进行了比较。采用了顺行低温心脏停搏和4℃缺血保存6小时的犬心脏移植模型。使用氧合血预充的离体心脏标本进行再灌注以及工作心脏的心肌力学和能量学研究。6个UW心脏中有6个、6个ST心脏中有4个进入工作阶段。通过三轴声纳测量法和高保真微测法在不同流量下生成的压力-容积环的计算机辅助分析显示，ST组和UW组在最大弹性（UW，4.2±1.1；ST，4.0±0.7）、可招募前负荷搏功（UW，43.7±7.3；ST，43.4±8.7）或对数线性舒张末期压力-容积曲线斜率（UW，0.057±0.01，ST，0.061±0.01）方面的功能无显著差异。在心脏停搏后、保存后、再灌注后和工作阶段后采集用于测定心肌含水量的标本。两组在再灌注后组织含水量均显著增加（UW，75.7%±0.5%至81.6%±0.2%，p = 0.0001；ST，76.5%±0.4%至83.4%±0.3%，p = 0.0002），且在工作阶段后仍持续存在（UW，81.5%±0.9%，p = 0.0002；ST，82.6%±0.1%，p = 0.0003）。两组均表现出再灌注后心肌含水量增加，但UW组的这种水肿明显较轻（p = 0.0001）。（摘要截断于250字）
