Study of Cardiac Lymph with Special Reference to Cardiac Surgery

从外科手术病理生理学的角度，对犬心肌缺血与心脏淋巴的关系进行了实验研究。在以前的研究中，我们已经阐明了缺血心肌和心脏淋巴产生之间的密切关系。本系列实验研究是为分析心脏淋巴动态变化对缺血心肌的影响机制而准备的。实验研究包括心脏淋巴引流的观察和通过控制冠脉血流量来防治心肌缺血。第一步，我们认识到心肌梗死面积的大小与心脏淋巴产量显著相关(p<0.01)。心肌缺血者也可见心肌水肿。然后，实验的目的是从因缺血而死亡的心肌中主动引流心脏淋巴。为此，给透明质酸酶静脉注射…。心脏淋巴容量增加，效果满意。我们将通过闭塞冠状动脉而排除冠脉血流的区域定义为“危险因素：R)，将完成心肌梗死的区域定义为”梗死区：I)。后一区经TTC染色病理证实。通过平面测量法比较两区的范围，使用透明质酸酶后，I/R比值明显降低。左心室重量的33.5&lt；正负12.3%与11.1&lt；正负12.3%(p<0.00u)。这一现象证明了心脏淋巴的主动引流对缺血心肌的保护起着重要作用。其次，为了弄清冠状动脉流量与心脏淋巴流量之间的关系，产生了任意管理冠状动脉血流量的AC旁路。用氢气清除法测定缺血心肌局部心肌血流量。冠脉流量减少至对照组的50%时，心脏淋巴流量并未减少，但心内膜局部心肌血流量明显高于心外膜(33.4%比29.8%)。然而，在患有透明质酸酶的病例中，结果似乎与此结果完全不同。缺血前后无明显变化，心内膜为8.5%，心外膜仅为3.0%。这是一个重要的结果，证明了心脏淋巴在心肌缺血中的作用，以及心脏淋巴的主动引流对预防心肌缺血损伤的重要性。

The relationship between myocardial ischemia and cardiac lymph has been studied experimentally in dogs from the point of view of surgical pathophysiology. In previous study we have clarified the close relationship between ischemic myocardium and cardiac lymph production. The present series of experimental study has been prepared for analysis of the mechanism in which the ischemic myocardium is influenced by dynamical change of the cardiac lymph. The experimental study sonsists of the observation of cardiac lymph drainage and the measures for myocardial ischemia by means of control of the coronary blood flow.In the first step we recognized the fact that the extent of the area of infarction significantly correlated to the production of cardiac lymph(p 0.01). Myocardial edema was also seen in cases with myocardial ischemia. The experiment was then directed to active drainage of cardiac lymph from the myocardium succumbed to ischemia. For this purpose, hyaluronidase was given intra-venousl … More y. The result was satisfactory with increased cardiac lymph volume. We defined the area excluded from coronary flow by means of occlusion of the coronary vessel as "risk factor : R) and the area completed myocardial infarction as "infarcted area : I). The latter area was confirmed pathologically by TTC staining. In comparison of the extent between both areas by means of planimetry, the ratio of I/R significantly decreased a fter the use of hyaluronidase. The data was 33.5<plus-minus>12.3% of the left ventricular ma ss vs. 11.1<plus-minus>12.3%(p 0.00u). This phenomenon was a proof that an active drainage of cardiac lymph played an important role to selvage the ischemic myocardium. In the next, for the purpose to clarify the relationship between the flow volume of the coronary artery and the cardiac lymph volume, AC-bypass was produced for arbitrary management of the volume of the coronary blood flow. Besides, regional myocardial blood flow on the ischemic myocardium was measured using hydrogen gas clearance method. Reduction of the coronary flow to 50% of the control did not reduced the cardiac lymph flow but the regional myocardial blood flow in prominence with endocardium than epicardium (33.4% vs. 29.8%) . However in cases with hyaluronidase the result was appeared completely differed from this result. There was insignificant change between pre and post ischemia revealing 8.5% in the endocardium and only 3.0% in the epicardium, respectively. This is a significant result that prove the role of cardiac lymph under myocardial ischemia and the importance of active drainage of cardiac lymph for prevention of an ischemic damage of the myocard Less