The Experimental study for establishment of safty cargioplegia in neonatal open heart surgery

新生儿心脏直视手术中安全性小腿麻痹建立的实验研究

• 批准号: 05671111
• 负责人: MURAOKA Ryusuke
• 金额: $ 1.34万
• 依托单位: Fukui Medical School
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (C)
• 财政年份: 1993
• 资助国家: 日本
• 起止时间: 1993 至 1994
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-05671111/
• 关键词: neonatal heart; cardioplegia; UW solusion; 新生児乳児期心筋保護; ハイドロキシエチルスターチ

Protection of the ischemic myocardium has been a major problem with open heart surgery in the neonate. Although University of Wisconsin (UW) solution is effective for the preservation of other organs, its protective effects are reduced in hypothermic conditions between 15-20 ﾟC,which is the typical temperature during open heart surgery. As this reduction in efficiency is due to the high potassium concentration of UW solution, we developed a lowpotassium version of UW solution (LPUW), replacing most of the potassium ions with sodium ions and making the concentration of potassium and calcium the same as in St. Thomas's Hospital cardioplegic solution No.2 (STS) (K : 16 mM,Ca : 1.2 mM). Recorery of cardiac function from hypothermic ischemia between 15-20 ﾟC was tested in isolated hearts from newborn rabbits (day 3-6) perfused with LPUW and results were compared with those obtained using conventional high-potassium UW solution and STS.Modified Krebs-Henseleit bicarbonate buffer (KH) was use … More d to represent hypothermia alone. After perfusing in the working mode for 30 minutes, the isolated heart was injected and arrested with one of the four cardioplegic solutions. Ischemia was maintained for either 180 minutes at 15 ﾟC of 360 minutes at 20 ﾟC (a total of 8 groups, each consisting of 7 samples). Subsequently, the heart was perfused again for 15 minutes in Langendorff mode and 30 minutes in the working mode. Hemodynamic parameters were recorded before and after the arrest, and subsequently compared. Percent recovery of aortic flow after ischemia for 360 minutes at 20 ﾟC was 40.3(]SY.+-。[)113.3 %, 79.3(]SY.+-。[)10.0%, 64.3(]SY.+-。[)11.9%, and 43.9(]SY.+-。[)15.9% (mean (]SY.+-。[) standard deviation) for HPUW,LPUW,STS,and KH,respectively. LPUW demonstrated the most favorable protective effects among the four solutions (p<0.05), while HPUW demonstrated significantly worse protection compared with LPUW and STS (p<0.01). In the case of ischemia for 180 minutes at 15 ﾟC,a similar tendency was observed, although no significant difference was observed between LPUW and STS.Concentrations of adenosine triphosphate and creatine phosphate in the cardiac muscle after ischemia tended to be higher with LPUW,although no significant difference was observed between LPUW and STS.In conclusion, LPUW solution was superior to conventional UW solution with regard to recovery from hypothermic ischemia between 15-20 ﾟC of the isolated heart from neonate rabbit. This observation supports the clinical application of LPUW solution for open heart surgery in newborn patients. Less

缺血心肌的保护一直是新生儿心内直视手术的主要问题。尽管威斯康星州大学（UW）溶液对保存其他器官有效，但在15-20 ℃之间的低温条件下，其保护作用会降低，这是心脏直视手术期间的典型温度。由于这种效率的降低是由于UW溶液的高钾浓度，我们开发了低钾版本的UW溶液（LPUW），用钠离子代替大部分钾离子，并使钾和钙的浓度与St.托马斯医院心脏停搏液2号（STS）（K：16 mM，Ca：1.2 mM）中的相同。用改良Krebs-Henseleit碳酸氢盐缓冲液（KH）灌注新生兔（3-6天）离体心脏，观察LPUW对15-20 ℃低温缺血心功能恢复的影响，并与常规高钾UW液和STS进行比较。 ...更多信息 d仅代表体温过低。在工作模式下灌注30分钟后，注射四种心脏停搏液中的一种并停搏。缺血在15 ℃下维持180分钟或在20 ℃下维持360分钟（总共8组，每组由7个样品组成）。随后，心脏在Langendorff模式下再灌注15分钟，在工作模式下再灌注30分钟。记录停搏前后的血流动力学参数，并进行比较。在20 ℃缺血360分钟后，主动脉血流的恢复百分比为40.3（± SY）。[）113.3%，79.3（）SY. ±. [）10.0%，64.3（）SY. ±. 11.9%，43.9%（±）SY。[）15.9%（平均值（±）. [标准偏差]）。在四种溶液中，LPUW表现出最有利的保护作用（p<0.05），而HPUW表现出与LPUW和STS相比显著较差的保护作用（p<0.01）。在15 ℃下缺血180分钟的情况下，观察到类似的趋势，尽管在LPUW和STS之间没有观察到显著差异。缺血后心肌中三磷酸腺苷和磷酸肌酸的浓度在LPUW中倾向于更高，尽管在LPUW和STS之间没有观察到显著差异。LPUW液对新生兔离体心脏15-20 ℃低温缺血的恢复作用上级优于常规UW液。这一观察结果支持LPUW溶液在新生儿患者心脏直视手术中的临床应用。少