目的 比较组氨酸-色氨酸-酮戊二酸（HTK）液单纯低温浸泡、持续灌注与间断灌注对离体兔心保存移植后的复跳效果。 方法 健康2月龄新西兰兔共36只，随机分为3组，即单纯低温浸泡组（单纯组）10只、持续灌注组（持续组）10只和间断2 h灌注组（间断组）16只。麻醉后取出心，建立HTK液经主动脉根部灌注停跳保护心，悬挂于Langendorff灌注模型上，K-H缓冲液平衡灌注5~10 min心搏动达稳定状态；根据分组灌注HTK液5~6 ml(30 ml/kg)使心停搏，4 ℃保存心8 h。连接压力传感器，收集冠脉流出液，比较各组心复跳时间等相关指标。比较3组心肌组织形态学差异。 结果 离体心均成功复跳，间断组复跳时间、1 min和5 min心律失常评分、平均心率、心律失常发生率以及肾上腺素注射次数均小于其它两组，单纯组最大（P<0.05）。复跳后间断组心肌酶CK-MB和肌钙蛋白I水平低于其它两组，单纯组最高（P<0.05）。复跳5 min后间断组左心室收缩压和冠状静脉流量高于其它两组，单纯组最低（P<0.05）。间断组心肌细胞水肿最轻，炎性细胞浸润的程度最低，而单纯组最严重。 结论 间断2 h灌注HTK液较持续灌注或单纯低温浸泡对降低离体兔心复跳后心律失常的发生和心肌损伤，以及改善左心血流动力学方面表现更加突出，为一种简单、高效、安全的移植心保存方法。
Abstract
Objective To compare re-beating effect after preservation and transplantation of isolated rabbit heart with simple low temperature immersion, continuous or intermittent perfusion of Histidine-tryptophan-ketoglutarate (HTK) solution. Methods 36 healthy New Zealand rabbits, with 2 months old, with mean weight 2.15 kg , were chosen and divided randomly into the following three groups: a simple low temperature immersion group (simple group, n=10), a continuous group (n=10) and an intermittent 2h perfusion (intermittent group, n=16). The rabbits were taken out the isolated heart after anesthetization to establish HTK solution through aortic root, the hearts were suspended on Langendorff perfusion model. K-H buffer solution was perfused for 5~10 minutes to stable heart pulsation. HTK solution was perfused about 5 ~ 6 ml (30ml/kg) according to the grouping to store heart at 4 ℃ for 8 hours. Then pressure transducer and coronary effluent were collected Cardiac resuscitation time, the difference of myocardial histomorphology and other related indexes among the three groups were compared. Results The isolated hearts were re-beating successfully in the three groups. The resuscitation time, arrhythmia score after 1 minute and 5 minutes, average heart rate, arrhythmia incidence and time of epinephrine injections in the intermittent group were all significantly lower than those of the continuous group and the simple group (P<0.05). CK-MB and cTnI levels in the intermittent group were less than those of the continuous group and the simple group (P<0.05). The LVSP and CSF values after re-beating 5min in the intermittent group were higher than those of the continuous group and the simple group (P<0.05). The degrees of myocardial cellular edema and inflammatory cell infiltration in the intermittent group were the lowest, but the above indexes in the simple group were the highest. Conclusions Intermittent 2 hours perfusion of HTK solution may be more effective in reducing arrhythmia and myocardial injury, improving left ventricular hemodynamics after cardiac resuscitation in isolated rabbit hearts than continuous perfusion or simple hypothermic immersion, which is expected to be a simple, efficient and safe method for preserving transplanted hearts.
关键词
HTK液 /
间断灌注 /
心移植 /
复跳 /
心律失常 /
CK-MB /
肌钙蛋白I /
血流动力学
Key words
Histidine-tryptophan-ketoglutarate solution /
Intermittent perfusion /
Transplantation /
Re-beating /
Arrhythmia /
Creatine kinase isoenzymes /
Troponin I /
Hemodynamics
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