远程预处理与终末血停搏液在体内仔猪模型中的协同作用。

Synergistic effects of remote perconditioning with terminal blood cardioplegia in an in vivo piglet model.

机构信息

Department of Cardiac Surgery, Jikei University School of Medicine, Tokyo, Japan.

Clinical Research Support Center, Jikei University School of Medicine, Tokyo, Japan.

出版信息

Eur J Cardiothorac Surg. 2017 Sep 1;52(3):479-484. doi: 10.1093/ejcts/ezx198.

DOI:10.1093/ejcts/ezx198

PMID:28874030

Abstract

OBJECTIVES

This study tested the hypothesis that remote perconditioning offers effective and synergistic cardioprotection to terminal warm blood cardioplegia for prompt ventricular recovery after prolonged cardioplegic arrest in an in vivo piglet model.

METHODS

Twenty-four piglets were subjected to 120 min of single-dose cardioplegic arrest and were divided into 4 groups according to the mode of reperfusion: control (simple aortic unclamp), remote perconditioning, terminal warm blood cardioplegia or remote perconditioning + terminal warm blood cardioplegia; remote perconditioning (4 cycles of 5-min ischaemia-reperfusion of the lower limb) was applied prior to aortic unclamping. Left ventricular systolic and diastolic functions were assessed by pressure-volume loop analysis at baseline and after 60 min of reperfusion. Biochemical injury was evaluated by plasma troponin T level.

RESULTS

The control group showed decreased end-systolic elastance, preload recruitable stroke work and inverse of end-diastolic pressure-volume relationship of 51.3 ± 14.0%, 46.1 ± 22.5% and 34.8 ± 14.9%, respectively. Percentage recovery of end-systolic elastance and preload recruitable stroke work were significantly better with terminal warm blood cardioplegia (with or without remote perconditioning) (end-systolic elastance: 95% confidence interval, 38.6-84.1; preload recruitable stroke work: 95% confidence interval, 0.4-54.3). Percentage recovery of inverse of end-diastolic pressure-volume relationship was significantly better in the remote perconditioning groups (with or without terminal warm blood cardioplegia) (95% confidence interval, 1.6-41.6). No synergistic effects of remote perconditioning and terminal warm blood cardioplegia on troponin T release were noted.

CONCLUSIONS

Remote perconditioning offers promising synergistic cardioprotection to terminal warm blood cardioplegia, implicating potential clinical benefit by contributing to prompt left ventricular functional recovery during paediatric open-heart surgery.

摘要

目的

本研究旨在通过在活体小猪模型中测试假设，即远程预处理对单次剂量停搏后长时间停搏的温血停搏液复灌具有有效的协同心脏保护作用，从而为温血停搏液复灌后即刻心室复跳提供支持。

方法

24 只小猪经历了 120 分钟的单次剂量停搏，根据再灌注方式分为 4 组：对照组（单纯主动脉钳夹）、远程预处理组、终末温血停搏液组和远程预处理+终末温血停搏液组；在主动脉钳夹前应用远程预处理（下肢缺血-再灌注 4 个循环，每个循环 5 分钟）。通过压力-容积环分析在基线和再灌注 60 分钟后评估左心室收缩和舒张功能。通过血浆肌钙蛋白 T 水平评估生化损伤。

结果

对照组显示终末收缩弹性、前负荷可诱导的做功和舒张末期压力-容积关系的反转分别降低了 51.3%±14.0%、46.1%±22.5%和 34.8%±14.9%。终末温血停搏液（有或没有远程预处理）具有更好的终末收缩弹性和前负荷可诱导的做功恢复百分比（终末收缩弹性：95%置信区间，38.6-84.1；前负荷可诱导的做功：95%置信区间，0.4-54.3）。远程预处理组（有或没有终末温血停搏液）舒张末期压力-容积关系的反转恢复百分比明显更好（95%置信区间，1.6-41.6）。远程预处理和终末温血停搏液对肌钙蛋白 T 释放无协同作用。