【作者】 牛兆倬；

【导师】 池一凡；

【作者基本信息】 青岛大学 ， 心脏外科学， 2004， 硕士

【摘要】 目的:研究改良心肌保护液保存猪心原位心脏移植后的能量代谢、心脏超微结构及细胞凋亡的变化。 方法:体重50～60kg左右家猪22对,随机分为对照组(A组,n=11对)和改良组(B组,n=11对),A组以St.Thomas液作为心脏保存液,B组以改良心肌保护液作为心脏保存液。均在供体心脏热缺血5分钟后灌注心脏保存液,切取供心4℃低温保存4小时后,受体猪在全身麻醉、中低温体外循环下接受同种异体原位心脏移植。在供心再灌注后观察心脏复跳情况并测定心排量,多个时点抽取血标本测量肌钙蛋白I(cTnI)含量,切取供心心肌测定心肌含水量(MWC)、丙二醛(MDA)、三磷酸腺苷(ATP)含量,并行电镜超微结构观察,原位末端标记法检测心肌细胞凋亡。 结果:A组供心低温保存后心肌含水率、MDA高于B组,而ATP明显降低,有显著差异(P<0.05);超微结构改变有一定差别,两组心肌细胞凋亡均不明显。供心移植后,B组供心cTnI漏出少,血流动力学指标好于A组;A组心肌心肌细胞结构改变明显,凋亡水平明显高于B组(P<0.01)。 结论:改良心肌保存液对心肌的保护作用优于St.Thomas液。更多还原

【Abstract】 Objects To evaluate the effects of modified heart preservation solution on donor heart in metabolism, ultrastructure and apoptosis.Methods 22 pairs of porcine were randomly divided into group A (n = 11 pairs)and group B (n = 11 pairs). All the hearts of donor were subjected to 5 minutes warm ischemia, then the pigs in group A were perfused with St.Thomas cardioplegic solution and those in group B with modified solution for myocardial protection. All the hearts were preserved in the solutions at 4℃ for 4 hours and then were transplanted to receptor. We have oberserved the recovery of the heart and measure the data of Cardiac Output. The blood samples were collected in different time points to measure cTnI. The samples of the graft were taken to measure the MWC, MDA and ATP concentration . The changes of myocardium tissues under electronic microscope were described. The Apoptosis rate was valued with TUNEL methods.Result Compared with group A, group B showed lower MWC and MDA and more ATP, the difference was significant (P<0.05). Group B also indicated better heart function and lower cTnI after reperfusion. Apoptosis increased in both two groups after 2h reperfusion. Ultrastructure deteriorates significantly in the donor of group A.Conclution The modified heart preservation solution has better effects than the St.Thomas solution during orthotopic heart transplantation.更多还原