Page 21 - 麻醉与监护论坛2015年第3期

陆中原 陈 兵 摘要

杭州 117监护病房 310013 目的：评价逆行灌注心脏不停跳手术对心肌的保护作用。方法：选择15条健康的中华田园犬
分为三组，分别为中低温心脏停跳组（C组），浅低温心脏不停跳顺灌组（A组）和浅低温心脏不
停跳逆灌组（R组）。于T1（循环阻断前），T2（阻断后30分钟），T3（阻断后80分钟），T4（循
环开放后10分钟），T5（循环开放后40分钟）抽取静脉血和动脉血检测心肌损伤指标：肌钙蛋白
-I（c T n-I）、肌酸激酶同工酶（C K M B）、乳酸脱氢酶（L D H）及乳酸水平，并测动脉及静脉血的
血气分析以计算氧摄取率（E R O2），在T2，T3抽取A组冠状静脉窦回流血以及R组左冠状动脉口回
流血（R L）和右冠状动脉口回流血（R R）测定乳酸水平及心肌损伤指标。实验结束时取右心房以
及左右心室的内膜下和外膜下心肌标本行电镜检查。结果:1.各组心肌损伤指标在循环阻断后均升
高，循环开放后仍继续上升，R组心肌损伤指标低于C组，与A组差别意义不大；2.各组乳酸在循环
阻断后均升高，循环开放后仍继续上升，C组乳酸水平明显高于A、R两组，A组与R组相比差别意义
不大；3.各组氧摄取率在循环阻断后降低，A、R两组高于C组，且T4即明显恢复，C组氧摄取率在T4
仍低于循环阻断前，循环开放后40分钟显著上升， A、R两组相互之间差异不明显（p>0.05）；4.A
组冠状静脉回流血以及R组左、右冠状动脉口回流血测定乳酸水平及心肌损伤指标比较无明显差异
（p>0.05）。5.对心肌的电镜观察发现停跳组的心肌损伤较重，线粒体肿胀明显，可见线粒体嵴断
裂、模糊，空泡形成较多，而逆灌组与顺灌组的心肌损伤较轻。逆灌组左、右心室的内膜面和外膜
面的心肌组织其损伤程度相仿，与顺灌组的损伤程度差异不明显。结论：逆行灌注浅低温心脏不停
跳对左心系统和右心系统心肌保护的效果一致，与顺行灌注无明显差别，相对中低温心脏停跳的心
肌保护方式具有优越性。。

关键词：顺行灌注；逆行灌注；心脏不停跳；心肌保护
责任作者：陈兵

逆行灌注心脏不停跳手术心肌保护的
实验研究

The Myocardial Preservation of Cadica Operation on Beating-

Heart

Z.-Y Lu, B. chen

Department of ICU, The PLA 117 Hospital, Hangzhou, 310013

Abstract

Objective. To evaluate the myocardial preservation of cadica operation on beating-heart.

Methods. A total of 15 dogs were divided into cardiac arrest group (C group,n=5), antegrade beating heart group
(A group,n=5) and retrograd beating heart group(R group,n=5). Myocardialtroponin-I (cTn-I),creatinekinase-MB (CK-
MB) and lactate dehydrogenase(LDH) were detected T1(before aortic clamped), T2(after aortic clamped 30min),T3(after
aortic clamped 80min) and T4(after aortic unclamped 10min), T5(after aortic unclamped 40min). Level of lactate was
also detected. The arterial oxygen concent and venous oxgen conent were detected. Oxygen extraction rate(ERO2) were
calculated at same time. Levels of lactate ,CKMB,cTn-I and LDH from blood returned from coronary of A group and R group
were detected at T2,T3. The ultrastructural changes of the mitochondria were observed under electronic microscope.

Results. 1.CKMB,cTn-I and LDH of A group and R group were lower than C group and there was no difference at
between A group and R group at the same time. 2.Compared with C group,Levels of lactate of A group and R group were
lower and there was no difference at between A group and R group. 3.ERO2 of A group and R group were higher(p<0.01)
than C group and there was no difference at between A group and R group.4.Levels of lactate ,CKMB,cTn-I and LDH of
blood returned from coronary which were acquired A group and R group were no difference.5.Crista mitochondriales
raritas and dissolve were seen in C group under electronic microscope, the degree of injury in A group and R group were
lightened.

Laboratory and Clinical Investigation 52 FAM 2015 Jan/Feb Vol.22 Issue 1
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