Takahashi A, Hearse D J, Braimbridge M V, Chambers D J
Cardiovascular Research, Rayne Institute, St. Thomas Hospital, London, England.
J Thorac Cardiovasc Surg. 1990 Sep;100(3):371-8.
Current procedure for harvesting human donor hearts for long-term storage before transplantation involves direct infusion of a hypothermic (4 degrees C) crystalloid cardioplegic solution into the normothermic (37 degrees C) heart in situ. We used the isolated perfused working rat heart preparation to investigate whether infusing cold crystalloid solutions into normothermic blood-containing hearts was consistent with maximal myocardial protection. Hearts (n = 6 per group) were excised and subjected to a primary (1 minute) infusion with either the St. Thomas' Hospital cardioplegic solution or a bicarbonate buffer solution, at 7.5 degrees C, 22 degrees C, or 37 degrees C. This was followed by a secondary infusion (2 minutes) with cold (7.5 degrees C) cardioplegic solution, after which all hearts were stored at 7.5 degrees C for 6 hours and then reperfused at 37 degrees C for 60 minutes, during which time creatine kinase leakage and cardiac function were measured. Primary infusion with warm solutions resulted in (1) decreased coronary vascular resistance during cardioplegic infusion and (2) greater postischemic cardiac function. This suggests that their use, before the standard cold infusion, might be beneficial to the long-term preservation of transplant donor hearts.
目前，在移植前获取人类供体心脏进行长期保存的程序是将低温（4℃）晶体心脏停搏液直接灌注到原位常温（37℃）心脏中。我们使用离体灌注工作大鼠心脏标本，研究向含血常温心脏灌注冷晶体溶液是否符合最大程度的心肌保护。将心脏（每组n = 6）切除，分别用圣托马斯医院心脏停搏液或碳酸氢盐缓冲溶液在7.5℃、22℃或37℃下进行首次（1分钟）灌注。随后用冷（7.5℃）心脏停搏液进行二次灌注（2分钟），之后所有心脏在7.5℃下保存6小时，然后在37℃下再灌注60分钟，在此期间测量肌酸激酶泄漏和心脏功能。用温溶液进行首次灌注导致（1）心脏停搏液灌注期间冠状动脉血管阻力降低，以及（2）缺血后心脏功能增强。这表明在标准冷灌注之前使用温溶液可能有利于移植供体心脏的长期保存。
