Shimada Y, Yamamoto F, Yamamoto H, Kumada Y, Kagisaki K, Ishikawa T, Oka T, Kawashima Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Jul;43(7):973-81.
The aim of this study was to determine the effect of the continuous perfusion with Krebs-Henseleit bicarbonate buffer (KHBB) solution or St. Thomas' Hospital cardioplegic solution (ST solution) containing glucose and insulin upon the post-preservation recovery in the isolated rat heart.
Hearts from male Wistar rats (n = 6/group) were subjected to working perfusion with KHBB solution for measurement of cardiac function. They were continuously perfused (1) with KHBB solution or ST solution for 12 hours at 20 degrees C, (2) with ST solution for 12 hours at 37 degrees C, 20 degrees C or 4 degrees C, (3) with ST solution or ST solution containing glucose (9 mmol/L) for 12 hours at 20 degrees C or 4 degrees C, and (4) with ST solution containing glucose (9 mmol/L) or ST solution containing glucose (9 mmol/L) and insulin (10 U/L solution) for 20 hours at 20 degrees C. This was followed by 15 min of Langendorff perfusion and 20 min of working perfusion with KHBB solution. During the second working perfusion after preservation, cardiac function was measured again.
(1) Percent recoveries of cardiac output (%CO) preserved with KHBB and ST solution were 44.9 +/- 4.0 and 57.7 +/- 3.8%, respectively (p < 0.05). (2) %CO after preservation with ST solution at 37, 20, 4 degrees C were 0*, 57.7 +/- 3.8 and 74.4 +/- 2.2*%, respectively (*p < 0.05 vs the 20 degrees C group). (3) At 20 degrees C, glucose addition to ST solution increased %CO to 76.5 +/- 2.4% from 57.7 +/- 3.8% in glucose-free ST solution group (p < 0.05). However, at 4 degrees C, glucose addition to ST solution was rather harmful and decreased %CO to 61.4 +/- 2.8% from 74.4 +/- 2.2 in glucose-free ST solution group (p < 0.05). (4) The addition of insulin to the glucose-containing ST solution resulted in a significant increase in %CO from 24.6 +/- 4.0% in the insulin-free solution to 69.2 +/- 2.0%.
Our results indicate that 1) ST solution might be better than KHBB solution for a continuous perfusion medium of myocardial preservation, and 2) at 20 degrees C, the addition of glucose and insulin to the ST solution could be beneficial for the continuous infusion as a method of preservation, however, at 4 degrees C, these addition might be harmful, suggesting the temperature dependence in the utility of energy substrate.
本研究的目的是确定用含葡萄糖和胰岛素的克雷布斯 - 亨泽莱特碳酸氢盐缓冲液（KHBB）溶液或圣托马斯医院心脏停搏液（ST溶液）持续灌注对离体大鼠心脏保存后恢复的影响。
雄性Wistar大鼠的心脏（每组n = 6）用KHBB溶液进行工作灌注以测量心脏功能。它们被持续灌注：（1）在20℃下用KHBB溶液或ST溶液灌注12小时；（2）在37℃、20℃或4℃下用ST溶液灌注12小时；（3）在20℃或4℃下用ST溶液或含葡萄糖（9 mmol/L）的ST溶液灌注12小时；（4）在20℃下用含葡萄糖（9 mmol/L）的ST溶液或含葡萄糖（9 mmol/L）和胰岛素（10 U/L溶液）的ST溶液灌注20小时。随后进行15分钟的Langendorff灌注和20分钟的用KHBB溶液的工作灌注。在保存后的第二次工作灌注期间，再次测量心脏功能。
（1）用KHBB和ST溶液保存后的心输出量恢复百分比（%CO）分别为44.9±4.0和57.7±3.8%（p < 0.05）。（2）在37℃、20℃、4℃下用ST溶液保存后的%CO分别为0*、57.7±3.8和74.4±2.2%（*p < 0.05，与20℃组相比）。（3）在20℃时，向ST溶液中添加葡萄糖使%CO从无葡萄糖ST溶液组的57.7±3.8%增加到76.5±2.4%（p < 0.05）。然而，在4℃时，向ST溶液中添加葡萄糖相当有害，使%CO从无葡萄糖ST溶液组的74.4±2.2%降至61.4±2.8%（p < 0.05）。（4）向含葡萄糖的ST溶液中添加胰岛素导致%CO从无胰岛素溶液中的24.6±4.0%显著增加到69.2±2.0%。
我们的结果表明，1）对于心肌保存的持续灌注介质，ST溶液可能比KHBB溶液更好；2）在20℃时，向ST溶液中添加葡萄糖和胰岛素作为一种保存方法的持续输注可能是有益的，然而，在4℃时，这些添加可能是有害的，这表明能量底物的效用存在温度依赖性。
