中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (31): 5745-5748.doi: 10.3969/j.issn.1673-8225.2010.31.012

• 心肺移植 heart-lung transplantation • 上一篇    下一篇

肢体缺血预处理在未成熟心脏移植中的应用

杨  锋，宋剑非，郑  民，闫颖伟   

  1. 桂林医学院附属医院心胸外科，广西壮族自治区桂林市  541001
  • 出版日期:2010-07-30 发布日期:2010-07-30
  • 通讯作者: 宋剑非，教授，副院长，桂林医学院附属医院心胸外科，广西壮族自治区桂林市 541001
  • 作者简介:杨锋★，男，1982年生，福建省南平市人，汉族，2010年桂林医学院毕业，硕士，主要从事心肌保护方面的研究。 wineryangfeng@163.com
  • 基金资助:

    广西科学基金项目(桂科基0236068)“供体心脏不停跳和停跳保存方法对心肌保护的对比研究”。

Limb ischemic preconditioning in immature heart transplantation

Yang Feng, Song Jian-fei, Zheng Min, Yan Ying-wei   

  1. Department of Cardiothoracic Surgery, Affiliated Hospital of Guilin Medical College, Guilin  541001, Guangxi Zhuang Autonomous Region, China
  • Online:2010-07-30 Published:2010-07-30
  • Contact: Song Jian-fei, Professor, Department of Cardiothoracic Surgery, Affiliated Hospital of Guilin Medical College, Guilin 541001, Guangxi Zhuang Autonomous Region, China
  • About author:Yang Feng★, Master, Department of Cardiothoracic Surgery, Affiliated Hospital of Guilin Medical College, Guilin 541001, Guangxi Zhuang Autonomous Region, China wineryangfeng@163.com
  • Supported by:

    the Science Foundation of Guangxi Zhuang Autonomous Region, No. 0236068*

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摘要：

背景：有学者提出远隔器官预处理概念，即在心脏以外的器官施行缺血预处理，同样能达到缺血预适应效果。肢体缺血预处理是一项机体自我调节的保护机制，但是对未成熟心肌保护的研究较少，在心脏移植方面的利用价值尚未明确。
目的：通过对未成熟幼犬进行肢体缺血预处理，与传统心脏保存方法比较，试图分析肢体缺血预处理在供体心脏保存中的应用价值。
方法：纳入未成熟幼犬12只，按随机数字表法分为2组，每组6只，采用有创性方法游离股动脉，肢体缺血预处理组夹闭股动脉10 min，开放5 min，3个循环后常规开胸，游离心脏，插灌注管，灌注st.Thomas停跳液，离体心脏于保护液中4 ℃保存(离体前取上腔静脉血3 mL)。对照组游离股动脉但不夹闭，余同实验组。在心脏保存时期(3 h)内每隔半小时取左心室心肌样本，3 h后取心尖部心肌烘干测得干湿比。测量心肌组织丙二醛含量、超氧化物歧化酶活性及肌钙蛋白Ⅰ含量。
结果与结论：离体前心肌组织肌钙蛋白Ⅰ含量无明显变化(P > 0.05)，离体后肢体缺血预处理组的心肌丙二醛含量及干湿比均低于对照组(P < 0.05)，超氧化物歧化酶活性高于对照组(P < 0.05)。结果提示，肢体缺血预处理对未成熟心脏有明显的保护作用，在未成熟供体心脏离体前进行缺血预处理可以提高供体心脏的保存效果，降低心肌水肿。离体前肌钙蛋白Ⅰ含量无变化说明肢体缺血预处理对心肌没有损伤，是一种安全的保护措施。

关键词: 肢体缺血预处理, 未成熟心肌, 心脏移植, 心肌保护, 犬

Abstract:

BACKGROUND: Some scholars propose that remote ischemic preconditioning can achieve ischemic preconditioning. Limb ischemic preconditioning is a self-regulating protective mechanism, whether it has protective effect on immature myocardium, and its value to heart transplantation remains unclear.

OBJECTIVE: To explore the value of limb ischemic preconditioning on the donor heart preservation by comparing immature canines limb ischemic preconditioning with the traditional method in heart preservation.
METHODS: A total of 12 canines were randomly divided into two groups, with 6 animals in each group. Femoral arteries were liberated and obstructed for 10 minites, followed by open 5 minutes, and then the chest was conventional opened after 3 cycles. The heart was dissociated, and ST.Thomas cardioplegia perfusion was infused via an inserted perfusion tube. The isolated hearts were preserved in the preservation fluid at 4 ℃ (3 mL blood was draw from the superior vena venous before the heart was removed). The treatment in the control group was similar to that of the experimental group except that the femoral arteries were not obstructed. The left ventricular myocardial samples were obtained every half an hour in the heart preservation duration     (3 hours), and the wet/dry ratio of apical myocardial was measured after preservation. The contents of malondialdehyde (MDA), superoxide enzyme (SOD), and cardiac troponin I (cTn-I) were measured. 
RESULTS AND CONCLUSION: Compared with the control group, the content of pre-cTn-I had no significant changes (P > 0.05), but the myocardial MDA and wet/dry ratio were smaller (P < 0.05), the SOD was greater (P < 0.05) after heart removal. The results demonstrated that, limb ischemic preconditioning has protective effects on immature heart. The limb ischemic preconditioning before heart removal can increase preservation outcomes of heart and decrease myocardial edema. The cTn-I content is not changed before heart removal showed that, the limb ischemic preconditioning has no damage to myocardium, thus, it is a safe protective measure.

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