摘要
目的探讨对无心跳供体(NHBD)的心脏进行移植的可行性,以及心肌保护液联合钠/氢交换抑制剂HOE-642对这种供心的保护效果。方法将健康雄性家猪24头随机分为实验组(E组,n=6)和对照组(C组,n=6)(每组12头,供、受各6头)。实验组供者采取主动脉快速完全放血法制成NHBD模型,取其心脏,冷浴保存4 h后进行移植。其中,实验组于供心热缺血前5 min静脉给予HOE-642(2 mg/kg)并以含HOE-642的Stanford液(4℃)灌洗和保存供心;供心吻合前经主动脉根部以含HOE-642的保护液(4℃,4∶1氧合血)灌注1次,吻合期间以同样的方法每隔30 min灌注一次;心脏吻合完毕主动脉开放后5 min内静脉给予HOE-642(2 mg/kg)。对照组供者经主动脉适量放血(心脏不停跳),造成热缺血,然后取其心脏,同样冷浴保存4 h后进行移植,但对照组的供心处理不用HOE-642,而是用等量生理盐水。采集供心主动脉根部放血前、心脏移植完毕主动脉开放后1 h(停机)以及主动脉开放后2 h(实验结束)3个时间点的血流动力学指标,测定供心的心肌含水量及心肌酶学指标,观察心肌细胞组织结构变化。结果两组在主动脉开放后均成功脱机。两组各检测点的左心室舒张末压、左心室峰发展压及左心室压力变化速率的差异均无统计学意义(P>0.05);实验组和对照组心肌组织含水量分别为(78.4±5.2)%和(76.3±3.1)%,其差异无统计学意义(P>0.05);两个时间点的心肌酶学指标差异无统计学意义(P>0.05);光镜下见两组的心肌纤维结构清楚,排列紧密,质未见炎性细胞浸润,也未见变性、坏死,电镜下见心肌细胞超微结构完整。结论 NHBD的供心可用于移植,其效果与有心跳者相近;HOE-642可增强心肌保护液对这种供心的保护效果。
OBJECTIVE To evaluate the possibility of heart transplantation with non-heart-beating donor（NHBD） graft,and the protective effects of combining cardioplegia with Na＋/H＋ exchange inhibitor HOE-642 on NHBD heart.METHODS Twenty-four male adult porcines were randomly assigned to experimental group（group E,n=6） and control group（group C,n=6）.Donor hearts in the group E were harvested from NHBD in which hearts arrest were induced by means of exsanguination,immersed in cold cardioplegia solution for 4 hours and followed by orthotropic heart transplantation.In addition,those donor hearts received an intravenous injection with HOE-642（2 mg/kg） 5 minutes before normothermia ischemia and were preserved with Stanford solution containing HOE-642.Those donor hearts were perfused with cardioplegia containing HOE-642 before transplantation and every 30 minutes during transplantation.At last,the aortic clamp was released and recipient animals received a single intravenous dose of HOE-642（2 mg/kg） 5 minutes after finishing the procedure.Donor hearts in the group C were harvested from heart-beating donor（HBD） and treated as in the group E but a substitute of HOE-642 was normal saline.All harvested hearts were followed by orthotropic heart transplantation.Left ventricular mechanica1 performance（LVPDP,LVEDP,±dp/dt） were examined 1 hour and 2 hours after the aortic clamp released,myocardia1 water content were determined,myocardial enzymes were evaluated and myocardium tissues were also analyzed under light microscopy and electron microscopy.RESULTS All animals were weaned from cardiopulmonary bypass successfully.There were no significant differences between the group E and group C in left ventricular mechanica1 performance（P〉0.05）,myocardia1 water content（P〉0.05） and myocardia1 enzymes（P〉0.05）.There was no serious cell damage when examined under
出处
《中国体外循环杂志》
2011年第1期32-35,47,共5页
Chinese Journal of Extracorporeal Circulation
关键词
钠/氢交换抑制剂
HOE-642
心脏移植
无心跳供体
Sod ium-hydrogen exchange inh ib itor
HOE-642
Heart transp lantation
Non-heart-beating donor
