不同心脏保护方法对胎羊体外循环的影响：一项随机对照试验

Effect of different cardioprotective methods on extracorporeal circulation in fetal sheep: a randomized controlled trial.

作者信息

Yan Yi-Bo, Shi Shuo, Wu Qian-Biao, Cai Jin-Sheng, Lei Bin-Feng

机构信息

Department of Cardiac Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China.

Department of Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China.

出版信息

J Cardiothorac Surg. 2021 Apr 17;16(1):94. doi: 10.1186/s13019-021-01486-y.

DOI:10.1186/s13019-021-01486-y

PMID:33865409

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8052754/

Abstract

BACKGROUND

Congenital heart disease is a leading cause of death in newborns and infants. The feasibility of fetal cardiac surgery is linked to extracorporeal circulation (ECC); therefore, cardioplegic solutions need to be effective and long-lasting.

METHODS

Eighteen pregnant sheep were divided into an ECC-only group, St. Thomas' Hospital cardioplegic solution (STH1) group (STH group), and HTK preservation solution (Custodiol®) group (HTK group). Markers of myocardial injury including troponin I (cTnI), troponin T (cTnT) and creatine kinase myocardial band (CKMB) were measured at specific time points (T1: pre-ECC, T2: 30 min of ECC, T3: 60 min of ECC, T4: 60 min post-ECC, T5: 120 min post-ECC). Myocardial tissue was removed from the fetal sheep at T5, and apoptosis was detected by TUNEL staining.

RESULTS

Changes in the serum cTnI, cTnT and CKMB concentrations were not significantly different among the three groups before and during the ECC(T1,T2,T3). At 60 min after ECC shutdown(T4), cTnI and cTnT concentrations were significantly higher in the STH group than before the start of ECC. The concentration of cTnI was higher in the STH group than in the HTK and ECC-only groups. The concentration of cTnT was higher in the STH group than in the ECC-only group. At 120 min after ECC shutdown(T5), cTnI and cTnT concentrations were significantly higher in the ECC and HTK groups than before the start of ECC, and CKMB concentration was significantly higher in STH and HTK groups. The concentrations of cTnT, cTnI and CKMB was higher in the STH group than in the HTK and ECC-only groups. The number of TUNEL-positive cells in the HTK and STH groups was higher than in the ECC-only group. The number of TUNEL-positive cells in the STH group was higher than in the HTK group. There was no statistically significant difference among the groups in the heart rate and mean arterial pressure after ECC.

CONCLUSION

The HTK preservation solution was significantly better than STH1 in reducing the release of cardiomyocyte injury markers and the number of apoptotic cells in fetal sheep ECC. Fetal sheep receiving ECC-only had an advantage in all indicators, which suggests ECC-only fetal heart surgery is feasible.

摘要

背景

先天性心脏病是新生儿和婴儿死亡的主要原因。胎儿心脏手术的可行性与体外循环（ECC）相关；因此，心脏停搏液需要有效且持久。

方法

将18只怀孕绵羊分为单纯ECC组、圣托马斯医院心脏停搏液（STH1）组（STH组）和HTK保存液（Custodiol®）组（HTK组）。在特定时间点（T1：ECC前，T2：ECC 30分钟，T3：ECC 60分钟，T4：ECC后60分钟，T5：ECC后120分钟）测量心肌损伤标志物，包括肌钙蛋白I（cTnI）、肌钙蛋白T（cTnT）和肌酸激酶心肌型（CKMB）。在T5时从胎羊身上取出心肌组织，通过TUNEL染色检测细胞凋亡。

结果

在ECC前及ECC期间（T1、T2、T3），三组血清cTnI、cTnT和CKMB浓度变化无显著差异。在ECC停止后60分钟（T4），STH组的cTnI和cTnT浓度显著高于ECC开始前。STH组的cTnI浓度高于HTK组和单纯ECC组。STH组的cTnT浓度高于单纯ECC组。在ECC停止后120分钟（T5），ECC组和HTK组的cTnI和cTnT浓度显著高于ECC开始前，STH组和HTK组的CKMB浓度显著升高。STH组的cTnT、cTnI和CKMB浓度高于HTK组和单纯ECC组。HTK组和STH组的TUNEL阳性细胞数高于单纯ECC组。STH组的TUNEL阳性细胞数高于HTK组。ECC后各组心率和平均动脉压无统计学显著差异。