Comparison of Intermittent Warm and Cold Blood Perfusion During Hypothermie Myocardial Preservation on Functional and Metabolic Recovery
Comparison of Intermittent Warm and Cold Blood Perfusion During Hypothermie Myocardial Preservation on Functional and Metabolic Recovery
复制标题
低温心肌保存过程中间歇温冷血液灌注对功能和代谢恢复的比较
DOI：
10.1111/j.1540-8191.1999.tb01276.x
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发表时间：
1999
影响因子：
1.6
通讯作者：
R. Parker
中科院分区：
文献类型：
--
作者：
T. Masters;F. Robicsek;A. Fokin;Joseph W. Cook;G. Gong;S. Jenkins;H. Rice;Charles Dobbins;R. Parker
许多技术被用于维持术中心脏活力。本文介绍的研究评价了在间断性温血和冷血灌注下保存长达4小时的不同时间后的心脏功能和代谢。使用冷却至10°C并维持1、2、3和4小时的异位心脏模型，比较了各种保存技术。心肌代谢的变化通过左心室肌的底物摄取和高能磷酸盐的活检样本来确定。保存技术包括：（1）持续低温，（2）1或2小时的持续温血灌注伴纤维性颤动，（3）在保存2、3和4小时期间的间歇性冷血灌注，（4）在保存2、3和4小时期间的间歇性温血灌注，和（5）对照组（不保存）。常温纤颤对保存后的功能或代谢参数没有影响。持续低温降低功能恢复与缺血时间成正比。冷间歇程序保持功能和代谢优于持续低温，而温暖的间歇保存保持功能和代谢在整个恢复期的所有保存技术的控制水平。ATP的变化反映了功能的变化。磷酸肌酸（CP）显着减少，在心脏隔离和保存，超过对照组的100%，在再灌注过程中。对于2小时或更短时间的手术，功能和代谢恢复不受所应用的各种保存方法的影响。心肌保护以间断温热灌注效果最好。低温时的复温循环可提供一定程度的预适应，对再灌注心肌有保护作用。
Abstract Numerous techniques are used to maintain intraoperative heart viability. The studies presented here evaluated heart function and metabolism after various periods of preservation up to 4 hours with intermittent warm and cold blood perfusion. Using a het‐erotopic heart model cooled to 10°C and maintained for 1, 2, 3, and 4 hours, various preservation techniques were compared. Changes in myocardial metabolism were determined from substrate uptakes and biopsy samples of the left ventricular muscle for high‐energy phosphates. Preservation techniques included: (1) sustained hypothermia, (2) 1 or 2 hours of sustained warm blood perfusion with fibrillation, (3) intermittent cold blood perfusion during 2, 3, and 4 hours of preservation, (4) intermittent warm blood perfusion during 2, 3, and 4 hours of preservation and (5) a control group (no preservation). Normothermic fibrillation had no effect on postpreservation functional or metabolic parameters. Sustained hypothermia reduced functional recovery proportional to the length of ischemia. The cold intermittent procedures maintained function and metabolism better than sustained hypothermia, while warm intermittent preservation maintained function and metabolism at control levels throughout the recovery period for all preservation techniques. Changes in ATP mirrored the functional changes. Creatine phosphate (CP) was markedly reduced during heart isolation and preservation and exceeded the control by 100% during reperfusion. For operative procedures of 2 hours or less, functional and metabolic recovery was not affected by the various preservation methods applied. Warm intermittent perfusion during hypothermie preservation offered the best protection for the myocardium. The warming cycles during hypothermia may provide some degree of preconditioning and protect the myocardium during reperfusion.
缺血预处理对心肌缺血时间质嘌呤代谢物和乳酸积累的影响。
影响因子：
37.8
作者：
VanWylen,DG
通讯作者：
VanWylen,DG