Chemla D, Jayais P, Ecoffey C, Declere A D, Lecarpentier Y
Département d'Anesthésiologie et de Physiologie Cardiorespiratoire, Université Paris Sud, Hôpital de Bicêtre, France.
Anesthesiology. 1997 Aug;87(2):378-86. doi: 10.1097/00000542-199708000-00026.
During orthotopic liver transplantation (OLT), acute depression of myocardial contractility has been suspected at the time of the graft reperfusion.
The authors tested the hypothesis that plasma collected at the time of reperfusion in OLT patients exerted a negative inotropic effect on isolated rat myocardium. Plasma from 13 OLT patients was collected either before surgical incision (group 1, n = 8) or 3-5 min after vena cava and portal vein unclamping (group 2, n = 9). Six patients had their pre- and postincision plasma analyzed. A postreperfusion syndrome was observed in 3 of 13 patients. Left ventricular rat papillary muscles were studied at baseline (T0), 30 min after the addition of plasma (T30), and 60 min after the addition of plasma (T60). The authors recorded contraction parameters (maximum unloaded shortening velocity [Vmax], peak extent of systolic shortening at preload [deltaL], maximum active isometric tension [AFi], positive peak tension derivative [+dFi/dt], time-to-peak shortening [TPS], and time-to-peak force [TPF]) and relaxation parameters (maximum lengthening velocity at preload [VI], negative peak tension derivative [-dFi/dt], index of load sensitivity of relaxation [tRi]).
In group 1, contraction parameters remained unchanged, with the exception of a decreased Vmax at T30 and AFi at T60 (each P < 0.05). In group 2, all contraction parameters were significantly decreased at T30 and at T60, with the exception of AFi at T60. Both types of plasma decreased V1 and altered tRi at T30 and T60, whereas only reperfusion plasma decreased -dFi/dt at T30 and T60. At T30, deltaL, -dFi/dt, and tRi were significantly more impaired in group 2 than in group 1. There was no relationship between inotropic changes and mean arterial pressure decrease at the time of reperfusion.
Plasma collected at the time of graft reperfusion in OLT patients exerted negative effects on contraction and relaxation performance in isolated rat left ventricular papillary muscle.
在原位肝移植（OLT）过程中，人们怀疑在移植物再灌注时心肌收缩力会急性下降。
作者检验了以下假设，即OLT患者再灌注时采集的血浆对离体大鼠心肌具有负性变力作用。从13例OLT患者中采集血浆，其中8例在手术切口前采集（第1组），9例在腔静脉和门静脉夹闭后3 - 5分钟采集（第2组）。对6例患者的切口前后血浆进行了分析。13例患者中有3例观察到再灌注综合征。对大鼠左心室乳头肌在基线（T0）、添加血浆后30分钟（T30）和添加血浆后60分钟（T60）进行研究。作者记录了收缩参数（最大无负荷缩短速度[Vmax]、前负荷下收缩期缩短的峰值程度[δL]、最大主动等长张力[AFi]、正性峰值张力导数[+dFi/dt]、达到峰值缩短的时间[TPS]和达到峰值力的时间[TPF]）以及舒张参数（前负荷下最大延长速度[VI]、负性峰值张力导数[-dFi/dt]、舒张负荷敏感性指数[tRi]）。
在第1组中，收缩参数保持不变，但T30时Vmax降低，T60时AFi降低（均P < 0.05）。在第2组中，除T60时的AFi外，所有收缩参数在T30和T60时均显著降低。两种血浆在T30和T60时均降低了VI并改变了tRi，而只有再灌注血浆在T30和T60时降低了 -dFi/dt。在T30时，第2组的δL、 -dFi/dt和tRi受损程度明显高于第1组。变力变化与再灌注时平均动脉压降低之间无相关性。
OLT患者移植物再灌注时采集的血浆对离体大鼠左心室乳头肌的收缩和舒张性能产生负面影响。
