Nakata S, Imai Y, Satoh K, Oshitomi T
Department of Pediatric Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Jul;44(7):899-905.
We studied in anesthetized dogs, the effects of cardiopulmonary bypass with normothermic blood, crossclamping of the aortic root, and continuous warm blood cardioplegia as a part of circulatory support on the ability of the recovery of the deteriorated myocardial function, and compared this method with the circulatory support under empty beating stage. Eleven dogs were subjected to the deteriorated myocardial function by 30 minute normothermic ischemic arrest and myocardial function was measured (baseline function). In 5 dogs (Group A), coronary perfusion of 5 ml/kg/min with normothermic blood was established under empty beating state. In other 6 dogs (Group B), the aorta was then clamped and 30 minute infusion of warm blood contained 15 mEq/l of potassium and 2 mEq/l of Magnesium was given by 2.5 ml/kg/min as a part of circulatory support. After this, aortic clamp was released and coronary perfusion of 5 ml/kg/min with normal warm blood followed under empty beating state. Cardiac function was measured at the periods of 40, 60 and 90 minutes of circulatory support and compared between the two groups. The parameters of left ventricular function (developed pressure, dp/dt, -dp/dt) were deteriorated by 30 minutes ischemia by about 50% compared with baseline function. In Group a, they improved gradually along with the duration of circulatory support and 90 minutes were required to return to the baseline function. In Group B, however, their % recovery reached 100% at the period of 40 minutes and maintained over 100% thereafter. RSMF could recover myocardial function from ischemic damage more quickly and effectively compared with circulatory support under empty beating state.
我们在麻醉犬身上进行研究，观察常温血液心肺转流、主动脉根部交叉钳夹以及持续温血心脏停搏作为循环支持的一部分对恶化心肌功能恢复能力的影响，并将该方法与空跳阶段的循环支持进行比较。11只犬通过30分钟常温缺血停搏导致心肌功能恶化，并测量心肌功能（基线功能）。5只犬（A组）在空跳状态下建立5ml/kg/min的常温血液冠状动脉灌注。另外6只犬（B组）随后夹闭主动脉，并以2.5ml/kg/min的速度输注含15mEq/l钾和2mEq/l镁的温血30分钟作为循环支持的一部分。之后，松开主动脉夹，在空跳状态下以5ml/kg/min的速度进行常温正常血液冠状动脉灌注。在循环支持40、60和90分钟时测量心脏功能，并在两组之间进行比较。与基线功能相比，左心室功能参数（舒张末压、dp/dt、-dp/dt）因30分钟缺血而恶化约50%。在A组中，它们随着循环支持时间的延长而逐渐改善，需要90分钟才能恢复到基线功能。然而，在B组中，它们在40分钟时恢复率达到100%，此后维持在100%以上。与空跳状态下的循环支持相比，RSMF能更快、更有效地使心肌功能从缺血损伤中恢复。
