血利钾心停搏液和双向灌注心肌保护的实验研究

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1、血利钾心停搏液和双向灌注心肌保护的实验研究章晓华，张镜方，吴若彬，肖学钧，陈萍【关键词】心停搏液摘要：目的　通过与三种经典心肌保护方法比较，探讨含血利多卡因高钾(血利钾)心停搏液和双向灌注心肌保护法的心肌保护作用。方法犬20只，随机分成四组(n=5)，分别用晶体心停搏液(CG1)、冷稀释血心停搏液(CG2)、常温稀释血心停搏液(CG3)及血利钾心停搏液(EG)。每组均经历120min心脏缺血。观察心脏停搏情况、冠状静脉窦回流血量及心肌酶浓度、心肌细胞内钙离子(Ca2+)和丙二醛(MDA)及三磷酸腺苷(ATP)含量、心肌形态学改变。结果①实验组(EG)心

2、脏停搏时间短，心停搏液用量少，冠状静脉血流量及心肌氧摄取率在缺血前后无明显变化；②血清心肌酶水平各组间无显著差异；③EG再灌注心肌Ca2+超负荷及ATP含量下降较CG3明显，与CG2相似；④EG再灌注心肌MDA水平较CG1显著降低。⑤心肌形态学改变各组间无显著差异。结论　血利钾心停搏液和双向灌注具有确切的心肌保护作用。　　关键词：缺血-再灌注损伤；心停搏液；心肌保护；体外循环　　CardioprotectiveEffectsofLidocaine-Hyperpotassium-BloodCardioplegicSolutionia-Reperfusio

3、nInjuryinCanineHearts　　Abstract:OBJECTIVEToinvestigatethemyocardialprotectiveeffectsoflidocaine-hyperpotassium-bloodcardioplegicsolutionostyocardialprotection.METHODS20adultcaninesonarybypass(CPB)andrandomizedtoreceivefourmyocardialprotectiveprotocolsrespectively(5ineachgroup):c

4、oldsupplementingSt.ThomasHospitalcrystalloidsolutioncardioplegiaantegradelyandintermittently(CG1),hypothermicbloodcardioplegiaantegradelyandintermittently(CG2),bloodcardioplegiaantegradelyandcontinuously(CG3),andlidocaine-hyperpotassium-bloodcardioplegiaittedto120minutesofmyocar

5、dialischemiaanda30minutesperiodofreperfusion.Arrestoftheheartandcoronaryvenoussinusflocardiacenzymesandmyocardialintracellularmalondiadehyde(MDA),ioncalcium(Ca2+),adenosinetriphosphate(ATP)easured.Myocardialstructurechangesafterischemiaandreperfusionicroscope.RESULTSLidocaine-hy

6、perpotassium-bloodcardioplegicsolutioneofarrestoftheheart,anddecreasedthevolumeofcystalloidcardioplegicsolutionused.Thereyocardialretrievaloxygen(MRO)betiainallgroups.TherecardiacenzymesafterischemiaparingEGilartoCG2.ThelevelofmyocardialintracelluarMDAafter30minutesreperfusionin

7、EG-bloodcardioplegicsolutionandbineddeliveryroutesrepresentsasimple,safeandeffectivemethodofmyocardialprotectionaybeanalternativetotraditionalcardioprotectivetechniques.　　Keyia-reperfusioninjury;cardioplegicsolution;myocardialprotection;cardiopulmonarybypass　　心停搏液的成分、灌注方式及不同心肌保护

8、方法的选用等仍存在争议〔1-3〕。含血利多卡因高钾心停搏液(简称血利钾心停搏液)及双向性灌注心