Balderman S C, Bhayana J N, Binette P, Chan A, Gage A A, Alder R H
J Thorac Cardiovasc Surg. 1981 Dec;82(6):860-9.
To establish whether hypothermic crystalloid potassium cardioplegia given in multidose fashion provides adequate preservation of myocardial ultrastructure and high-energy phosphates, we studied 25 patients with an ejection fraction of 50% or higher who were undergoing cardiac procedures. Eight patients had three biopsy specimens taken from the left ventricular apex for determination of adenosine triphosphate (ATP) and creatine phosphate (CP). Specimens were taken immediately prior to aortic cross-clamping, immediately after the release of the aortic cross-clamp, and 30 minutes after the release of the cross-clamp. Seventeen patients had six specimens taken form the left ventricular apex at the above-stated times, three for ATP and CP determination and three additional specimens for electron microscopy. One patient had a small perioperative infarction and another patient died on the fifth postoperative day of an aortic dissection. The mitochondria on the electron microscopic specimens were graded on a scale from 0 to 4 (4 = severe changes). There was no significant difference in the mitochondrial scores. The preservation oh high-energy phosphates was less complete. ATP was reduced to 78% (3.4.2) of control and CP was reduced in the immediate postclamp period to 32% (081/2.5)of control. The difference are particularly significant if one looks at patients whose aortic cross-clamp time was 90 minutes or more (12 patients). In this group, ATP an CP preservation were 71% of control (3.33/4.60 mmoles/kg. wet weight) and 53% of control (l.48/2.81), 30 minutes after clamp removal (p equal to or less than 0.01). We conclude that hypothermic potassium cardioplegia gives excellent preservation of the myocardial ultrastructure in man. However, the preservation of high-energy phosphates with this technique is imperfect.
为确定多剂量低温晶体钾停搏液能否充分保护心肌超微结构和高能磷酸化合物，我们研究了25例射血分数为50%或更高且正在接受心脏手术的患者。8例患者从左心室心尖取3个活检标本，用于测定三磷酸腺苷（ATP）和磷酸肌酸（CP）。标本分别在主动脉阻断前即刻、主动脉阻断松开后即刻以及松开后30分钟采集。17例患者在上述时间从左心室心尖取6个标本，3个用于ATP和CP测定，另外3个用于电子显微镜检查。1例患者围手术期发生小面积梗死，另1例患者在术后第5天死于主动脉夹层。电子显微镜标本上的线粒体按0至4级评分（4级 = 严重改变）。线粒体评分无显著差异。高能磷酸化合物的保存不太完全。ATP降至对照值的78%（3.4.2），CP在阻断后即刻降至对照值的32%（081/2.5）。如果观察主动脉阻断时间为90分钟或更长时间的患者（12例），差异尤为显著。在该组中，阻断解除后30分钟，ATP和CP的保存率分别为对照值的71%（3.33/4.60微摩尔/千克湿重）和53%（1.48/2.81）（p≤0.01）。我们得出结论，低温钾停搏液能很好地保护人体心肌超微结构。然而，用这种技术保存高能磷酸化合物并不理想。
