Development of cardioplegia for newborn cardiac surgery.

为阐明缺血期间无氧糖酵解在新生儿心脏继发性再灌流损伤发生中的作用，我们观察了葡萄糖和脱氧葡萄糖(DG)对体外培养的新生(2-5天)兔心脏灌流的影响。在圣托马斯医院停跳液(ST)诱导心脏骤停后，进行180min的低温缺血。ST组加入葡萄糖(5 MM)或DG(5 MM)。再灌流30min后左室发展压恢复率、冠脉流出液乳酸/丙酮酸比值(L/P)及CK漏出量分别为(^*p&lt；L/P比值CK漏出ST 72.7+3.3 23.3+1.2 41.5+13.0ST+葡萄糖58.9+3.9^*36.9+4.4^*40.0+5.3 ST+DG 96.3+1.4^*17.3+3.8^*18.9+4.5^**添加葡萄糖后，反映心肌氧化还原状态的指标L/P显著升高。DG可显著增加LVDP的%rec，降低L/P和CK漏出量。这些结果提示，心肌缺血时的无氧糖酵解为更大的钙超载与Na+/H+和Na+/Ca~(2+)交换提供了阶段，从而导致更大的心肌损伤。提出了DG在心脏停跳液中的潜在应用价值。

To elucidate the role of anaerobic glycolysis durnig ischemia for the genesis of subsequentreperfusion injury in neonatal hearts, we investigated the effects of glucose and deoxyglucose(DG) on isolated neborn(2-5 days) rabbit hearts perfused in vitro. Following cardiac arrest induced by St. Thomas' Hospital cardioplegic solution(ST), the hearts were subjected to hypothermic ischemia for 180 min. Glucose(5mM) or DG(5mM) was added to ST. Percentage recovery of left ventricular developed pressure(LVDP) after 30 min reperfusion, lactate/pyruvate ratio(L/P) in the coronary effluent during the first minute of reperfusion and CK leakage were as follows(^*p<0.05 vs ST, ANOVA) :%rec LVDP L/P ratio CK leakageST 72.7+3.3 23.3+1.2 41.5+13.0ST+glucose 58.9+3.9^* 36.9+4.4^* 40.0+5.3ST+DG 96.3+1.4^* 17.3+3.8^* 18.9+4.5^*Addition of glucose resulted in a decrease in % rec of LVDP and an increase in L/P, an index of redox state. DG application caused a significant increase in % rec of LVDP and a decrease in L/P as well as in CK leakage. These results suggested that anaerobic glycolysis during in neonatal hearts during ischemia mya set a stage for larger Ca overload with Na+/H+ and Na+/Ca2+ exchange, leading to greater myocardioal injury. potential usefulness of DG in cardioplegia was proposed.