急性心肌梗死心脏手术中的血液停搏液：两种广泛使用溶液的大鼠实验
Blood cardioplegia for cardiac surgery in acute myocardial infarction: rat experiments with two widely used solutions.
作者信息
Boening Andreas, Assling-Simon Lena, Heep Martina, Boengler Kerstin, Niemann Bernd, Schipke Julia, Mühlfeld Christian, Grieshaber Philippe
机构信息
Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany.
Department of Physiology, Justus Liebig University, Giessen, Germany.
出版信息
Interact Cardiovasc Thorac Surg. 2018 Jul 1;27(1):88-94. doi: 10.1093/icvts/ivy011.
OBJECTIVES
Blood cardioplegia (BCP) can be used in different ways to protect the heart from ischaemia-reperfusion injury during cardiac surgery. Because there could be differences between warm and cold intermittent cardioplegia with or without warm reperfusion, we investigated the influence of 2 blood cardioplegia solutions on cardiac function, metabolism and infarct size in stable and infarcted rat hearts.
METHODS
The hearts of 32 male Wistar rats were excised and inserted into a blood-perfused isolated heart apparatus. In 16 hearts, an acute myocardial infarction was induced by ligation of the left anterior descending coronary artery at least 30 min before aortic clamping. After aortic clamping, either Calafiore or Buckberg BCP was administered. During reperfusion, coronary blood flow, left ventricular developed pressure and dp/dt max were recorded, and oxygen consumption and lactate production were determined. The infarct size after 90 min of reperfusion was measured by triphenyl tetrazolium chloride staining. The hearts of rats without infarction were investigated using transmission electron microscopy.
RESULTS
In hearts without infarction, haemodynamic recovery was similar for Calafiore and Buckberg solutions: left ventricular developed pressure [Cala 62% of baseline (BL), Buck 58% BL] and dp/dt max (Cala 83% BL, Buck 89% BL). Coronary flow, which was slightly less in infarcted hearts, also recovered similarly after the administration of the 2 BCP solutions (Cala 65% BL, Buck 68% BL). During reperfusion, lactate production was similar (Cala 0.85 ml/min, Buck 1.0 ml/min), and the cellular oedema index and mitochondrial swelling were comparable between the 2 groups. In hearts with infarction, left ventricular developed pressure (Cala 58% BL, Buck 56% BL) and dp/dt max (Cala 79% BL, Buck 72% BL) showed similar recovery for reperfusion with Calafiore or Buckberg BCP. In addition, coronary flow recovered similarly (Cala 54% BL, Buck 57% BL). During reperfusion, myocardial oxygen consumption was lower in the Cala (67% BL) than in the Buck (82% BL) group, but lactate production was similar between the Cala (1.1 ml/min) and the Buck (1.1 ml/min) groups. Myocardial infarct size was also similar in the Cala group (24%) and in the Buck group (26%).
CONCLUSIONS
In stable perfused rat hearts and in an in vitro model of acute myocardial infarction, the 2 BCP solutions offer equally good myocardial protection.
目的
血液停搏液（BCP）可通过不同方式用于保护心脏在心脏手术期间免受缺血再灌注损伤。由于温血与冷血间歇性停搏液（有无温血再灌注）之间可能存在差异，我们研究了两种血液停搏液对稳定和梗死大鼠心脏的心脏功能、代谢及梗死面积的影响。
方法
将32只雄性Wistar大鼠的心脏取出，植入血液灌注的离体心脏装置。在16只心脏中，在主动脉夹闭前至少30分钟通过结扎左前降支冠状动脉诱导急性心肌梗死。主动脉夹闭后，给予卡拉菲奥雷（Calafiore）或巴克伯格（Buckberg）BCP。再灌注期间，记录冠状动脉血流量、左心室舒张末压和dp/dt max，并测定耗氧量和乳酸生成量。再灌注90分钟后通过氯化三苯基四氮唑染色测量梗死面积。对未梗死大鼠的心脏进行透射电子显微镜检查。
结果
在未梗死的心脏中，卡拉菲奥雷和巴克伯格溶液的血流动力学恢复相似：左心室舒张末压（卡拉菲奥雷为基线的62%，巴克伯格为58%）和dp/dt max（卡拉菲奥雷为83%，巴克伯格为89%）。梗死心脏中的冠状动脉血流量略少，在给予两种BCP溶液后也有相似的恢复（卡拉菲奥雷为65%，巴克伯格为68%）。再灌注期间，乳酸生成相似（卡拉菲奥雷为0.85 ml/min，巴克伯格为1.0 ml/min），两组间细胞水肿指数和线粒体肿胀情况相当。在梗死心脏中，卡拉菲奥雷或巴克伯格BCP再灌注时左心室舒张末压（卡拉菲奥雷为58%，巴克伯格为56%）和dp/dt max（卡拉菲奥雷为79%，巴克伯格为72%）显示出相似的恢复。此外，冠状动脉血流量恢复相似（卡拉菲奥雷为54%，巴克伯格为57%）。再灌注期间，卡拉菲奥雷组（67%）的心肌耗氧量低于巴克伯格组（82%），但卡拉菲奥雷组（1.1 ml/min）和巴克伯格组（1.1 ml/min）之间的乳酸生成相似。卡拉菲奥雷组（24%）和巴克伯格组（26%）的心肌梗死面积也相似。
结论
在稳定灌注的大鼠心脏和急性心肌梗死的体外模型中，两种BCP溶液提供同等良好的心肌保护。
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