Okamoto F, Allen B S, Buckberg G D, Young H, Bugyi H, Leaf J
J Thorac Cardiovasc Surg. 1986 Sep;92(3 Pt 2):583-93.
This study tests the hypothesis that improved muscle salvage after prolonged ischemia (4 hours) occurs when the substrate-enriched blood cardioplegic solution is markedly hyperglycemic (greater than 400 mg/dl) and markedly hyperosmotic (greater than 400 mOsm). Thirty-five dogs underwent 4 hours of occlusion of the left anterior descending coronary artery and reperfusion during total vented bypass with substrate-enriched blood cardioplegic solution, in which the glucose concentration and osmolarity were varied in relation to one another. Spontaneous systolic shortening recovered consistently (31 +/- 6%) only when glucose was greater than 400 mg/dl and osmolarity was greater than 400 mOsm. The least recovery occurred (only one of six dogs recovering spontaneous shortening) when cardioplegic glucose was greater than 400 mg/dl and osmolarity was greater than 400 mOsm. Regional segments reperfused with our standard substrate-enriched blood cardioplegic solution had lower transmural flow rates following reperfusion (56 versus 87 ml/100 gm/min, p less than 0.05), markedly reduced mitochondrial State 3 and State 4 respiration in epicardial and endocardial muscle (p less than 0.05), and the most extensive histochemical evidence of damage (63% area of nonstaining versus area at risk, p less than 0.05). We conclude that markedly increased levels of osmolarity (greater than 400 mOsm) and glucose (greater than 400 mg/dl) improve the capacity of substrate-enriched blood cardioplegic solution to salvage myocardium after prolonged ischemia.
当富含底物的血液停搏液显著高血糖（大于400mg/dl）且显著高渗（大于400mOsm）时，长时间缺血（4小时）后肌肉挽救情况会得到改善。35只犬在全心转流期间接受了4小时的左前降支冠状动脉闭塞，并使用富含底物的血液停搏液进行再灌注，其中葡萄糖浓度和渗透压相互变化。仅当葡萄糖大于400mg/dl且渗透压大于400mOsm时，自发收缩缩短才能持续恢复（31±6%）。当停搏液葡萄糖大于400mg/dl且渗透压大于400mOsm时，恢复情况最差（六只犬中只有一只恢复自发缩短）。用我们标准的富含底物的血液停搏液再灌注的区域节段在再灌注后透壁流速较低（56对87ml/100gm/min，p<0.05），心外膜和心内膜肌肉中的线粒体状态3和状态4呼吸显著降低（p<0.05），并且有最广泛的损伤组织化学证据（无染色面积与危险面积之比为63%，p<0.05）。我们得出结论，渗透压（大于400mOsm）和葡萄糖（大于400mg/dl）水平的显著升高可提高富含底物的血液停搏液在长时间缺血后挽救心肌的能力。
