The Study of Cardiac Lymph; Special Reference to Cardiac Surgery

本实验旨在阐明心脏淋巴动力学方面与心肌缺血损伤程度之间的关系。为此，我们闭塞了杂种犬的左冠状动脉前降支，并在心脏淋巴结处收集了这种情况下的心脏淋巴。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强。心肌缺血区心肌淋巴中酶（GOT、GPT、LDH等）浓度明显高于血清。淋巴流量增加和酶水平升高的现象在反应性充血再灌注期进一步加重。梗死区域的范围与心淋巴体积的增加密切相关。下一个实验是给药透明质酸酶，目的是积极清除缺血区域的心脏淋巴，结果显示它对减少梗死区域有显著的作用。梗死的危险区域(R)定义为与结扎冠状动脉分支一致的区域。梗死面积(I)以TTC染色呈阴性的程度来确定。使用透明质酸酶后，I/R显著降低（p<0.01）。值从44.1 1.1 （SE）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，即重量越小，I/R值越小。本实验系列的进一步研究旨在探讨心肌淋巴淤积与心肌梗死程度的关系。心肌淋巴淤积时梗死面积明显增大。

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.