補助人工心臓と化学的心筋蘇生併用による心停止症例救命への治療体系の確立

辅助人工心脏与化学心肌复苏相结合的心脏骤停救治体系的建立

• 批准号: 08771040
• 负责人: 野村 耕司
• 金额: $ 0.64万
• 依托单位: Jikei University School of Medicine
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Encouragement of Young Scientists (A)
• 财政年份: 1996
• 资助国家: 日本
• 起止时间: 1996 至 无数据
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-08771040/
• 关键词: 補助循環; 補助人工心臓; 血液心筋保護法; 心停止

【研究方法】対象は体重5-8kgのブタ10頭。膜型人工肺を用いた体外循環下に60分間の大動脈単純遮断、常温虚血を施工後、体外循環を終了し開心術後急性循環不全LOSモデルとした。うち5頭(補助循環施行群)では再度60分間の補助循環を施行。また他の5頭(Rescue Blood Cardioplegia併用群:Rescue BCP群)では補助循環開始後に大動脈を遮断し20分間の常温BCP(PH75-6,K 20mEq Ca0.5-7Glutamate Asperatate 13mM)を注入し心停止を維持した。両群で左室機能(コンダクタンス法によるEmax改善率)および心筋代謝(心筋酸素消費量MVO2、過剰乳酸値EL)の改善度を比較検討した。【結果】60分間の常温虚血後(開心術後LOS想定)の%Emax(術前血に対する改善率)は20【+-】5%と高度左室不全を認めた。補助循環群では60分の補助にて%Emaxは39%【+-】5と改善傾向を示したが、MVO2 37【+-】,EL27【+-】12%と好気性心筋代謝の障害が遷延した。これに対してRescue BCP群では20分間の一時的心停止を併用した60分の補助循環により%Emax75【+-】5% MVO2 67【+-】15%、EL57【+-】12%と心筋代謝および収縮性の有意に良好な改善を示し全例において人工心肺から容易に離脱しえた。【結論】開心術後LOSを想定したブタ急性心不全in vivoモデルにおいて短時間のwarm BCP arrestを補助循環施行時に併用するRescue Blood Cardioplegiaは障害心筋の好気性代謝、心収縮性の改善に極めて有効であり,このような化学的心筋蘇生法と補助人工心臓の併用により従来救命が困難であった重症心筋不全,心停止症例への効果が期待される。

【Research method】10 elephants weighing 5-8kg each. The membrane-type artificial lung was used to treat acute circulatory insufficiency after open-heart surgery, including 60-minute occlusion of the aorta under extracorporeal circulation, normal temperature blood deficiency, and termination of extracorporeal circulation. The subsidy cycle will be implemented again for 60 minutes in the うち5 head (subsidy cycle implementation group).また His 5 heads (Rescue Blood Cardioplegia combination group: Rescue BCP group) Supplementary circulation is started after the aorta is blocked and the normal temperature BCP (PH75-6, K 20mEq Ca0.5-7Glutamate Asperatate is used for 20 minutes 13mM) was injected to maintain cardiac arrest.両The improvement rate of left ventricular function (コンダクタンス法によるEmax) and myocardial metabolism (cardiac acid consumption MVO2, perlactic acid value EL) is compared. [Results] After 60 minutes of normal temperature blood deficiency (LOS scenario after open heart surgery), %Emax (preoperative blood test improvement rate) was 20 [+-] 5% and high-grade left ventricular insufficiency was recognized. The auxiliary circulation group is 60 minutes, and the supplement is %Emax, 39% [+-] 5, which shows improvement tendency, MVO2 37 [+-], and EL27 [+-] 12%, which is good at delaying the damage of cardiomyocardial metabolism.これに対してRescue BCP group では 20 minutes の momentary cardiac arrest を and use した 60 minutes の subsidy cycle に よ り %Emax75【+-】5% MVO2 67 [+-] 15%, EL57 [+-] 12%, cardiac metabolism, contractility, good improvement, complete example, artificial heart and lung, easy separation and separation. [Conclusion] LOS after open heart surgery can be determined by acute cardiac insufficiency in vivo, short-term warm BCP arrest, and concurrent use of rescue blood during supplementary circulation. Cardioplegia is very effective in improving the metabolism and cardiac contractility of the heart, and is very effective in improving the heart's chemical properties. It is difficult to save lives by supplementing the artificial heart and using it to save lives. It is also expected to be effective in cases of severe myocardial insufficiency and cardiac arrest.