Watanabe F
2nd Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Hokkaido Igaku Zasshi. 1987 Jul;62(4):544-57.
Cold chemical cardioplegia by the antegrade method is a useful, widely employed procedure for protecting the myocardium in aorto-coronary by pass surgery. Perfusion of a cardioplegic solution into the ischemic area is, however, insufficient in the presence of a severe lesion in the coronary artery, leading to postoperative cardiac hypofunction. We performed an experimental study using RCSP, which lessens this problem, in the excised dog heart. Hearts excised from 20 dogs were assigned to normal coronary artery groups (group I consisting of the hearts from 5 dogs and a perfusion solution temperature of 20 degrees C, group II consisting of the hearts from 5 dogs and a temperature of 30 degrees C) and blocked coronary artery groups (group III consisting of the hearts from 5 dogs and a temperature of 20 degrees C, group IV consisting of the hearts from 5 dogs and a temperature of 30 degrees C). RCSP was undertaken for two hours with a new modified Krebs solution. Hemodynamic and myocardial metabolic parameters during a given work load under fixed conditions and heart beat after reopening of the blood flow using our original function circuit were compared between the experimental groups and a control group (consisting of normal hearts studied immediately after excision from 5 dogs not given myocardial protection). In the group with normal coronary arteries, LVW and LV dp/dt were better in group I than in group II throughout the course; these values were significantly lower in group II than in the control group, but there was no significant difference between group I and the control group. These parameters were also improved in group III (with blocked coronary arteries), but there was no significant difference in improvement between group III and the control group 60 minutes after reperfusion. In group IV, on the other hand, improvement was poor. The myocardial metabolic parameters also showed approximately the same results. These results suggested that RCSP with the new modified Krebs' solution at perfusion temperature of 20 degrees C afforded effective protection of the myocardium for two hours. From the fact that a favorable protective effect of the myocardium was obtained in group III, as in group I, RCSP was considered to provide a useful procedure for protection of the myocardium in aorto-coronary bypass for severe or wide-ranging coronary artery diseases.
顺行法冷化学心脏停搏术是一种在主动脉冠状动脉搭桥手术中保护心肌的常用且广泛应用的方法。然而，在冠状动脉存在严重病变的情况下，将心脏停搏液灌注到缺血区域并不充分，会导致术后心脏功能减退。我们在离体犬心脏上使用减少这一问题的逆行性冠状动脉顺行灌注（RCSP）进行了一项实验研究。从20只犬身上取下的心脏被分为正常冠状动脉组（I组由5只犬的心脏组成，灌注液温度为20摄氏度；II组由5只犬的心脏组成，温度为30摄氏度）和冠状动脉阻塞组（III组由5只犬的心脏组成，温度为20摄氏度；IV组由5只犬的心脏组成，温度为30摄氏度）。使用一种新的改良克雷布斯溶液进行了两小时的RCSP。在固定条件下给定工作负荷期间的血流动力学和心肌代谢参数以及使用我们原有的功能回路重新开放血流后的心跳，在实验组和对照组（由从5只未给予心肌保护的犬身上切除后立即研究的正常心脏组成）之间进行了比较。在正常冠状动脉组中，整个过程中I组的左心室壁厚度（LVW）和左心室dp/dt比II组更好；II组中的这些值显著低于对照组，但I组和对照组之间没有显著差异。III组（冠状动脉阻塞）中的这些参数也有所改善，但再灌注60分钟后III组和对照组之间的改善没有显著差异。另一方面，IV组的改善较差。心肌代谢参数也显示出大致相同的结果。这些结果表明，在20摄氏度的灌注温度下使用新的改良克雷布斯溶液进行RCSP可有效保护心肌两小时。从III组与I组一样获得了良好的心肌保护效果这一事实来看，RCSP被认为是在主动脉冠状动脉搭桥手术中保护严重或广泛冠状动脉疾病心肌的一种有用方法。
