Saydjari R, Asimakis G, Conti V R
J Thorac Cardiovasc Surg. 1987 Aug;94(2):234-40.
Multidose cardioplegia has been reported to be superior to single-dose cardioplegia in protecting the heart during ischemia. However, large volumes of cardioplegic solution may be detrimental because of washout of adenine nucleotide degradation products that accumulate during ischemia, which limits recovery of adenosine triphosphate. We designed an experiment to test the effects of increasing the volume of cardioplegic solution on postischemic myocardial recovery. Four groups were studied: Group 1, initial 2 minute single dose of cardioplegic solution; Group 2, infusion of cardioplegic solution every 30 minutes for 1 minute; Group 3, infusion of cardioplegic solution every 20 minutes for 1 minute; and Group 4, infusion of cardioplegic solution every 20 minutes for 2 minutes. All groups were ischemic for 2 hours at 20 degrees C. Although washout of nucleotide degradation products during the ischemic interval increased with higher volumes of cardioplegic infusion, the total washout (infusion plus initial 5 minutes of reperfusion) was not different among all groups. The multidose groups recovered function better and had significantly higher levels of total tissue purines after 30 minutes of reperfusion. There was no difference in adenosine triphosphate levels among all groups after reperfusion. We conclude that increasing the volume of cardioplegic solution, within a clinically relevant range is not associated with increasing loss of adenine nucleotides from the cell or with impaired functional recovery of the heart.
据报道，在缺血期间保护心脏方面，多次剂量的心脏停搏液优于单次剂量的心脏停搏液。然而，大量的心脏停搏液可能是有害的，因为在缺血期间积累的腺嘌呤核苷酸降解产物会被冲洗掉，这限制了三磷酸腺苷的恢复。我们设计了一项实验来测试增加心脏停搏液体积对缺血后心肌恢复的影响。研究了四组：第1组，最初2分钟单次剂量的心脏停搏液；第2组，每30分钟输注1分钟心脏停搏液；第3组，每20分钟输注1分钟心脏停搏液；第4组，每20分钟输注2分钟心脏停搏液。所有组在20℃下缺血2小时。尽管在缺血期间随着心脏停搏液输注量的增加，核苷酸降解产物的冲洗增加，但所有组之间的总冲洗量（输注加再灌注最初5分钟）并无差异。多次剂量组恢复功能更好，再灌注30分钟后总组织嘌呤水平显著更高。再灌注后所有组之间的三磷酸腺苷水平没有差异。我们得出结论，在临床相关范围内增加心脏停搏液的体积与细胞内腺嘌呤核苷酸损失增加或心脏功能恢复受损无关。
