Reversal of ischemic damage with secondary blood cardioplegia.
Reversal of ischemic damage with secondary blood cardioplegia.
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用二次心脏停跳液逆转缺血性损伤。
DOI：
10.1016/s0022-5223(19)38055-9
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发表时间：
1979
期刊：
影响因子：
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通讯作者：
James V. Maloney
中科院分区：
文献类型：
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作者：
Harold L. Lazar;G. D. Buckberg;A. Manganaro;Robert P. Foglia;Heinz Becker;Donald G. Mulder;James V. Maloney
严重缺血性损伤后，通常需要延长转流时间以促进恢复。本研究测试的假设，即最好的逆转缺血性损伤是通过短暂rerererest缺血后的心脏与氧合心脏停搏液（二次血液心脏停搏液）的持续输注期间，旁路必须延长。20只狗进行了45分钟的常温缺血性停搏。松开后15分钟，没有心脏可以支持体循环。在所有的狗中，通过延长旁路30分钟来降低氧气需求。在其中10只犬中，通过在50 mm Hg压力下连续输注37° C血液心脏停搏液（K+28 mEq/L; pH 7.6; Ca++1 mEq/L）使心脏重新休息5分钟，进一步降低需求。用二次血液心脏停搏液处理的心脏在收缩率方面表现出更大的恢复（+dP/dt 75% vs 62%，p < 0.05）和舒张（-dP/dt 76% vs 58%，p < 0.05），顺应性恢复更好（85%对51%，p < 0.05），更高的每搏作功指数（0.72对0.50 gm-m/Kg，p < 0.05），并且增加氧摄取的能力更强（85%对45%，p < 0.05），以满足工作心脏的需求比单独延长转流处理的心脏。我们的结论是，短暂的，持续输注血液心脏停搏液的心脏rererest结果在更完全的逆转缺血性损伤比可能通过延长单独的旁路。我们认为，二次心脏停搏液恢复率的提高是由于输送的氧气转向修复过程，而不是在必须延长旁路的时间内不必要地消耗在机电工作上。
After severe ischemic injury, it is usually necessary to prolong bypass to enhance recovery. This study tests the hypothesis that the best reversal of ischemic damage is achieved by briefly rearresting the postischemic heart with a continuous infusion of an oxygenated cardioplegic solution (secondary blood cardioplegia) during the period when bypass must be prolonged. Twenty dogs underwent 45 minutes of normothermic ischemic arrest. Fifteen minutes after unclamping, no heart could support the systemic circulation. In all dogs, oxygen demands were lowered by extending bypass for 30 minutes. In 10 of these dogs, demands were further lowered by rearresting the heart for 5 minutes with a continuous infusion of a 37° C blood cardioplegic solution (K+28 mEq/L; pH 7.6; Ca++1 mEq/L) at a pressure of 50 mm Hg. Hearts treated with secondary blood cardioplegia showed greater recovery in the rate of contraction (+dP/dt 75% versus 62%, p < 0.05) and relaxation (-dP/dt 76% versus 58%, p < 0.05), better recovery of compliance (85% versus 51%, p < 0.05), a higher stroke work index (0.72 versus 0.50 gm-m/Kg, p < 0.05), and more ability to augment oxygen uptake (85% versus 45%, p < 0.05) to meet the demands of the working heart than hearts treated by prolonging bypass alone. We conclude that rearresting the heart with a brief, continuous infusion of a blood cardioplegic solution results in more complete reversal of ischemic damage than possible by prolongation of a bypass alone. We believe that the increased recovery with secondary cardioplegia results from diversion of delivered oxygen toward reparative processes rather than its being expended needlessly on electromechanical work during the time when bypass must be prolonged.