Robinson L A, Braimbridge M V, Hearse D J
Ann Thorac Surg. 1984 Sep;38(3):268-74. doi: 10.1016/s0003-4975(10)62250-3.
Although few surgeons dispute the benefits of high-potassium crystalloid cardioplegia, objective comparison of the efficacy of various formulations is difficult in clinical practice. We compared four commonly used cardioplegic solutions in the isolated rat heart (N = 6 for each solution) subjected to 180 minutes of hypothermic (20 degrees C) ischemic arrest with multidose cardioplegia (3 minutes every half-hour). The clinical solutions studied were St. Thomas' Hospital solution, Tyers' solution, lactated Ringer's solution with added potassium, and a balanced saline solution with glucose and potassium. Postischemic recovery of function was expressed as a percentage of preischemic control values. Release of creatine kinase during reperfusion was measured as an additional index of protection. St. Thomas' Hospital solution provided almost complete recovery of all indexes of cardiac function following ischemia including 88.1 +/- 1.6% recovery of aortic flow, compared with poor recovery for the Tyers', lactated Ringer's, and balanced saline solutions (20.6 +/- 6.5%, 12.5 +/- 6.4%, and 9.6 +/- 4.2%, respectively) (p less than 0.001). Spontaneous defibrillation was rapid (less than 1 minute) and complete (100%) in all hearts in the St. Thomas' Hospital solution group, but much less satisfactory with the other formulations. Finally, St. Thomas' Hospital solution had a low postischemic level of creatine kinase leakage, contrasting with significantly higher enzyme release in the other solutions tested (p less than 0.001). Although differences in composition are subtle, all potassium crystalloid cardioplegic solutions are not alike in the myocardial protection they provide. Comparative studies under controlled conditions are important to define which formulation is superior for clinical application.
尽管很少有外科医生质疑高钾晶体心脏停搏液的益处，但在临床实践中很难对各种配方的疗效进行客观比较。我们在离体大鼠心脏中比较了四种常用的心脏停搏液（每种溶液n = 6），使其在低温（20℃）缺血停搏180分钟，并采用多次剂量心脏停搏液（每半小时3分钟）。所研究的临床溶液为圣托马斯医院溶液、泰勒氏溶液、添加钾的乳酸林格氏溶液以及含葡萄糖和钾的平衡盐溶液。缺血后功能恢复以缺血前对照值的百分比表示。再灌注期间肌酸激酶的释放作为另一个保护指标进行测量。圣托马斯医院溶液在缺血后能使所有心脏功能指标几乎完全恢复，包括主动脉血流恢复88.1±1.6%，相比之下，泰勒氏溶液、乳酸林格氏溶液和平衡盐溶液的恢复情况较差（分别为20.6±6.5%、12.5±6.4%和9.6±4.2%）（p<0.001）。圣托马斯医院溶液组所有心脏的自发除颤迅速（<1分钟）且完全（100%），但其他配方的效果则差得多。最后，圣托马斯医院溶液缺血后肌酸激酶漏出水平较低，与其他测试溶液中显著更高的酶释放形成对比（p<0.001）。尽管成分差异细微，但所有钾晶体心脏停搏液在提供心肌保护方面并不相同。在受控条件下进行比较研究对于确定哪种配方在临床应用中更优很重要。
