中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (5): 831-834.doi: 10.3969/j.issn.1673-8225.2011.05.017

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

不停跳摘取和保存有完整心包的供心

梁胜景1，莫安胜1，林  辉1，张  帆2，温绍科1，周一凡1   

  1. 1广西壮族自治区人民医院心胸外科，广西壮族自治区南宁市 530021
    2武汉大学人民医院麻醉科，湖北省武汉市  430072
  • 收稿日期:2010-06-25 修回日期:2010-10-13 出版日期:2011-01-29 发布日期:2011-01-29
  • 通讯作者: 林辉，博士，主任医师，广西壮族自治区人民医院心胸外科，广西壮族自治区南宁市 530021 LinHui33622@ sina.com
  • 作者简介:梁胜景★，男，1969年生，广西壮族自治区平果县人，壮族，1993年北京大学医学院毕业，硕士，副主任医师，主要从事胸心外科基础和临床研究。 534305638@qq.com
  • 基金资助:

    广西壮族自治区自然科学基金资助项目(桂科攻0235024-1)。

Explanting and preservation of donor hearts with integrity pericardium in the beating state

Liang Sheng-jing1, Mo An-sheng1, Lin Hui1, Zhang Fan2, Wen Shao-ke1, Zhou Yi-fan1   

  1. 1Department of Cardiothoracic Surgery, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning  530021, Guangxi Zhuang Autonomous Region, China
    2Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan  430072, Hubei Province, China
  • Received:2010-06-25 Revised:2010-10-13 Online:2011-01-29 Published:2011-01-29
  • Contact: Lin Hui, Doctor, Chief physician, Department of Cardiothoracic Surgery, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China LinHui33622@sina. com
  • About author:Liang Sheng-jing★, Master, Associate chief physician, Department of Cardiothoracic Surgery, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China 534305638@qq.com
  • Supported by:

    the Natural Science Foundation of Guangxi Zhuang Autonomous Region, No. 0235024-1*

PDF

303

被引次数

3

摘要：

背景：有文献报道心脏在连续灌注、不停跳下保存，有望突破心脏保存时限。但是心脏的摘取和灌注部位沿用单纯低温保存的办法，有背于连续灌注保存的初衷。作者认为保留完整的心包，于头臂动脉干灌注，在不停跳下摘取和保存供体心脏可能更加科学。
目的：评价不停跳保存完整心包的可行性以及供心功能变化情况。
方法：选用年龄、体质量相当的广西巴马小型猪6只进行不停跳摘取和保存有完整心包供心的试验。实验猪用氯胺酮麻醉，取胸部正中切口，全身肝素化后，不切开心包，先阻断并切断头臂干插灌注管，后切断上腔静脉和右上肺静脉回收血液，用自行组装的灌注装置灌注心脏，在跳动状态下摘取心脏并保存4 h。设4个时点连续监测左心室心功能变化，离体时为T0，保存60 min为T1，保存120 min 为T2，保存180 min为T3，保存240 min为T4。
结果与结论：在不停跳下，摘取和保存有完整心包的供体心脏6例全部成功。不停跳保存各个时点的左心室内压最大上升速率两两比较：T0与其他时点比较，差异有显著性意义(P < 0.05)；T1与T2时点比较，差异无显著性意义(P > 0.05)；T1与T3及T4时点比较，差异有显著性意义(P < 0.05)。不停跳保存各个时点的左心室内压最大下降速率两两比较：T0与其他时点比较，差异有显著性意义(P < 0.05)；T1与T2，T3及T4时点比较，差异有显著性意义(P < 0.05)。结果表明在不停跳下摘取和保存有完整心包供心是完全可行的。

关键词: 心脏移植, 心脏不停跳, 供体心脏保存, 心脏摘取, 模型

Abstract:

BACKGROUND: Preservation duration of heart can be breakthrough if the heart was preserved in the beating state with continuous perfusion. However, the traditional explanting and preservation of heart is contrary to preservation with continuous perfusion. It is more scientific to explants and preserves heart with integrity pericardium in the beating state. 
OBJECTIVES: To evaluate feasibility of preservation heart in the beating state and to observe the functional changes of donor heart.
METHODS: Six guangxi bama mini-pigs were selected for this experiment. After pigs were anesthetized with ketamine, a median sternotomy was performed. And then, outside the pericardium, the descending aorta, the left subclavian artery, the superior vena cava, the inferior vena cava and the azygous vein were circumferentially mobilized and encircled with ties. The inferior vena cava was cut at the level of the diaphragm after heparinization. Additional venting was achieved with transection of the right superior pulmonary vein outside pericardium. The aortic cross-clamp was applied at the proximal of the descending aorta and the heart is continuous perfusion with blood through a needle inserted at the left subclavian artery. cardiectomy proceeds as the apex of the heart is elevated cephalad and any remaining intact pulmonary veins were divided. The descending aorta and the left subclavian artery were ligated and transected and the pulmonary arteries were divided distal to bifurcation. Once the explantation was complete, the left ventricle of heart was set with a Foleys (F12) through pulmonary vein and mitral orifice. At last, donor hearts were explanted with integrity pericardium and continuous perfuse in the empty beating state with perfusion apparatus for 4-hour in a sterile container. Four successive time points were set to monitor functional changes of left ventricle, namely, the moment after extraction was T0, 60, 120, 180 and 240 minutes after preservation was T1-T4, respectively. 
RESULTS AND CONCLUSION: Donor hearts excision with integrity pericardium and continuous perfusion preservation in the beating state were successfully performed in all 6 hearts. During preservation, comparison of the maximum ascending rate of left ventricular pressure (dp/dtmax) showed that, dp/dtmax in T0 was higher than other time points, the differences had significance (P < 0.05); but there was no significance between T1 and T2 (P > 0.05). The differences among T1 and T3/T4 had significance (P < 0.05). Comparison of maximum descending rate of left ventricular pressure (-dp/dtmax) showed, T0 was higher than in the other time points (P < 0.05); there was significance among T1, T2, T3 and T4 (P < 0.05). This new method is feasible in donor heart excision and preservation.

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