The Study of Cardiac Lymph; Special Reference to Cardiac Surgery

本实验试图阐明心脏淋巴动力学特征与心肌缺血损伤程度之间的关系。为此，阻断杂种犬的冠状动脉左前降支，并在此条件下在心脏淋巴结处收集心脏淋巴。在固定的时间间隔内研究心脏淋巴的流量和成分。结果表明，冠状动脉闭塞的心脏淋巴显示血流增加。酶浓度(谷草转氨酶、谷丙转氨酶、乳酸脱氢酶等)来自心肌缺血区的心脏淋巴比血清淋巴高得多。在反应性充血的再灌注期，淋巴流量增加和酶水平升高的现象进一步加重。梗死区的范围与心肌淋巴体积的增加密切相关。下一步应用透明质酸酶主动清除缺血区的心脏淋巴的实验表明，在缩小梗死区方面有显著的效果。梗塞危险区(R)定义为与结扎的冠状动脉支流相符合的面积。心肌梗死面积(I)为TTC染色阴性的范围。应用透明质酸酶后，I/R比值明显降低(P<0.01)。该值从44.1 1.1(东南)更改为9.4 4.9。干/湿重法测定的心肌含水量与此结果成比例相关，重量越小，I/R值越小。这一实验系列的进一步研究是针对心肌淋巴滞留和心肌梗死范围之间的关系。心肌淋巴淤积时，心肌梗死面积明显增大。

The experiment has been attempted to clarify the relationship between dynamical aspect of cardiac lymph and the extent of myocardial ischemic damage. For this purpose, the left anterior descending coronary artery of the mongrel dog was occluded and cardiac lymph under such a condition was collected at the cardiac lymph node. Flow volume and component of the cardiac lymph were studied at fixed intervals of time. The result clarified that the cardiac lymph with an occluded coronary artery revealed augmentation of the flow. Enzymes concentration (GOT, GPT, LDH, etc.) in the cardiac lymph originated from ischemic area of the myocardium were strikingly high in comparison with those in the serum. Both phenomena of increased lymph flow and augmented enzymes level were further aggravated in a phase of reperfusion with reactive hyperemia. An extent of the infarct area was well correlated to the increased volume of the cardiac lymph.The next experiment with administration of hyaluronidase intending an active remove of cardiac lymph from ischemic area revealed a prominent effect in reduction of the infarct area. The risk area (R) for infarction was defined as the area accorded with tributary of the ligated coronary artery. The infarct area (I) was determined as an extent where TTC dyeing appeared in negative. Then the ratio of I/R decreased significantly (p<0.01) after use of hyaluronidase. The values are changed from 44.1 1.1 (SE) to 9.4 4.9. Myocardial water content measured by dry/wet weight method was proportionally correlated to this result that the lesser weight to the smaller I/R value. Further study in this experimental series is directing to the relationship between myocardial lymphstasis and the extent of myocardial infarction. The area of infarction apparently increased under myocardial lymph stasis.