改良心肌保存液热缺血冷保存对猪心保护的作用_医学论文.docVIP

改良心肌保存液热缺血冷保存对猪心保护的作用_医学论文 改良心肌保存液热缺血冷保存对猪心保护的作用_医学论文 【摘要】 　　目的 研究改良心肌保存液在心脏移植术中对热缺血冷保存猪供心的心肌保存效果。方法 16对供猪随机分为2组，建立猪同种异体原位心脏移植模型。A组以St Thomas 液、B组以自制液作为停搏液、灌注冲洗液和保存液。供心心脏停搏热缺血5 min后，以停搏液灌注，切取心脏，4 ℃灌注冲洗并低温浸泡保存4 h，施行同种异体原位心脏移植。观察移植后心脏复搏的一般情况及血清肌酸激酶同工酶（CK）变化，常规苏木精伊红、PAS染色，光镜观察心肌组织。结果 浸泡保存后B组心肌含水量低于A组，复灌后CK含量也低于A组(t=2.89～3.38，0.05)。B组PAS糖原染色评分高于A组（T=24,0.01）。结论 改良的新型心肌保存液能较好恢复热缺血冷保存的猪供心心脏功能，减轻复灌后的心肌再灌注损伤，减少保存期间细胞内糖原的消耗，其对心肌的保护明显优于St Thomas液。 【关键词】 器官保存液 心脏移植 热缺血 心肌保护 　　［ABSTRACT］ Objective To study the protective effect of modified heart preservation solution on a pig heart with warm ischemia. Methods Sixteen pairs of pig were evenly divided into two groups in random. An allogeneil graft model of orthotopic heart in pig was established. In group A, St Thomas solution was used as cardioplegic solution, perfusion fluid, and preservative fluid in group B, selfmade solution was used. Donors’ hearts were subjected to warm ischemia for five minutes, then perfused with cold St Thomas solution or the cold modified solution, respectively, the hearts were removed and preserved in the aforementioned solutions at 4 ℃ for four hours, and the transplantation done. Serum creatine kinaseMB (CK MB), MDA and SOD in myocardium were detected. Results After storage in the solutions, no significant differences were noted between the two groups interms of MDA and SOD after reperfusion, the level of CKMB and MDA in myocardium was higher in group A, and SOD in myocardium was higher in group B. Conclusion Compared with St Thomas solution, the modified one offers better protection against warm ischemia of pig heart in terms of recovery of the heart function and decrease of reperfusion injury. 　　［KEY WORDS］ Organic preservation solution Heart transplantation Myocardial preservation Warm ischemia 　　心脏移植已经成为难以救治心脏疾病的重要治疗选择。随着心脏移植的发展,供心的供需矛盾日益突出。许多学者目前正探讨将热缺血一定时间的“尸心”用于移植的可能性。世界上正在对供心的保存，尤其是对供心保存液的配方不断进行研究和改进，以求更有效地长时间保存供心，提高心脏移植手术的成功率。我院心外科在深入研究分析目前国内外各种常用的心脏保存液的基础上，研制出新型的改良心脏保存液。本文旨在通过模