Gates R N, Lee J, Laks H, Drinkwater D C, Rhudis E, Aharon A S, Chung J Y, Chang P A
Department of Surgery, University of California Los Angeles Medical Center 90095-1741, USA.
Ann Thorac Surg. 1996 Nov;62(5):1388-91. doi: 10.1016/0003-4975(96)00497-3.
The maximum degree of microvascular distribution of cardioplegic solution is considered important to achieve optimum myocardial protection. This study attempts to demonstrate that the addition of retrograde cardioplegia to antegrade cardioplegia improves overall microvascular perfusion.
Explanted human hearts (n = 6) were treated with cold cardioplegic arrest and bicaval cardiectomy. Blood cardioplegia (37 degrees C) containing colored microspheres (color A for antegrade, color B for retrograde) was simultaneously infused antegrade at a pressure of 80 mm Hg and retrograde at a pressure of 40 mm Hg for 2 minutes. The ventricular myocardium was then sampled at three sites to determine absolute and relative cardioplegic microvascular flow.
Of the total microvascular capillary flow, 27% to 32% was found to be the contribution of retrogradely delivered cardioplegia.
Despite being delivered simultaneously and at a lower pressure, retrograde cardioplegia contributed substantially to overall microvascular perfusion. This suggests that antegrade cardioplegia alone does not perfuse all available myocardial capillaries and that the addition of retrograde cardioplegia enhances overall microvascular distribution and perfusion.
心脏停搏液的微血管最大分布程度被认为对实现最佳心肌保护很重要。本研究试图证明，在顺行心脏停搏基础上加用逆行心脏停搏可改善整体微血管灌注。
对6例离体人心脏进行冷心脏停搏和双腔静脉心脏切除术。含彩色微球（顺行为颜色A，逆行为颜色B）的血液心脏停搏液（37℃）同时以80mmHg的压力顺行灌注和以40mmHg的压力逆行灌注2分钟。然后在三个部位采集心室心肌样本，以确定心脏停搏液的绝对和相对微血管流量。
在总的微血管毛细血管流量中，发现逆行灌注的心脏停搏液贡献了27%至32%。
尽管逆行心脏停搏与顺行心脏停搏同时进行且压力较低，但它对整体微血管灌注有显著贡献。这表明仅顺行心脏停搏并不能灌注所有可用的心肌毛细血管，而加用逆行心脏停搏可增强整体微血管分布和灌注。
