CAJ | 학술논문

目的探讨无心跳供者(NHBD)的心脏进行移植的可行性,以及HOE-642联合尼可地尔对这种供心的保护效果.方法将健康雄性家猪随机分为实验组和对照组,实验组供者采取主动脉快速完全放血法制成NHBD模型,取其心脏,冷保存4 h后进行移植;对照组供者经主动脉适量放血(仍有心跳),造成热缺血,然后取其心脏,冷保存4 h后进行移植.实验组于供心热缺血前5 min静脉给予HOE-642(2 mg/kg);以含HOE-642和尼可地尔的4 ℃ Stanford液灌洗和保存供心;供心吻合前经主动脉根部以含HOE-642和尼可地尔的4 ℃ 4:1血心停搏液(高钾)灌注1次;供心吻合期间以含HOE-642和尼可地尔的4 ℃ 4:1血心停搏液(低钾)间断灌注;心脏吻合完毕主动脉开放后初始5 min时段内,静脉给予HOE-642(2 mg/kg).对照组的供心处理除不用HOE-642和尼可地尔外,其余同实验组.采集供心主动脉根部放血前、移植心脏吻合完毕主动脉开放后1 h(停机)以及主动脉开放后2 h(实验结束)3个时点的心脏血流动力学指标,测定移植心脏的心肌含水量,观察心肌的组织学变化.结果两组在主动脉开放后心肌红润,心脏搏动有力,均成功脱机.两组各检测时点的左心室舒张末压、左心室峰发展压及左心室压力变化速率的差异均无统计学意义(P＞0.05);实验组和对照组心肌组织含水量分别为(78.6±5.7)%和(76.4±4.2)%,其差异无统计学意义(P＞0.05);光镜下见两组的心肌纤维结构清楚,排列紧密,间质未见炎症细胞浸润,也未见变性、坏死,无排斥反应征象,电镜下见心肌细胞超微结构完整.结论 NHBD的供心可用于移植,其效果与有心跳者相近;HOE-642和尼可地尔联用可能对该类供心具有一定的保护作用.
목적 탐토무심도공자(NHBD)적심장진행이식적가행성,이급HOE-642연합니가지이대저충공심적보호효과.방법 장건강웅성가저수궤분위실험조화대조조,실험조공자채취주동맥쾌속완전방혈법제성NHBD모형,취기심장,랭보존4 h후진행이식;대조조공자경주동맥괄량방혈(잉유심도),조성열결혈,연후취기심장,랭보존4 h후진행이식.실험조우공심열결혈전5 min정맥급여HOE-642(2 mg/kg);이함HOE-642화니가지이적4 ℃ Stanford액관세화보존공심;공심문합전경주동맥근부이함HOE-642화니가지이적4 ℃ 4:1혈심정박액(고갑)관주1차;공심문합기간이함HOE-642화니가지이적4 ℃ 4:1혈심정박액(저갑)간단관주;심장문합완필주동맥개방후초시5 min시단내,정맥급여HOE-642(2 mg/kg).대조조적공심처리제불용HOE-642화니가지이외,기여동실험조.채집공심주동맥근부방혈전、이식심장문합완필주동맥개방후1 h(정궤)이급주동맥개방후2 h(실험결속)3개시점적심장혈류동역학지표,측정이식심장적심기함수량,관찰심기적조직학변화.결과 량조재주동맥개방후심기홍윤,심장박동유력,균성공탈궤.량조각검측시점적좌심실서장말압、좌심실봉발전압급좌심실압력변화속솔적차이균무통계학의의(P＞0.05);실험조화대조조심기조직함수량분별위(78.6±5.7)%화(76.4±4.2)%,기차이무통계학의의(P＞0.05);광경하견량조적심기섬유결구청초,배렬긴밀,간질미견염증세포침윤,야미견변성、배사,무배척반응정상,전경하견심기세포초미결구완정.결론 NHBD적공심가용우이식,기효과여유심도자상근;HOE-642화니가지이련용가능대해류공심구유일정적보호작용.
Objective To evaluate the possibility of heart transplantation with non-heart-beating donor (NHBD) graft, and the cardial protective effects of Na+/H+ exchange inhibitor (HOE-642) plus KATP channel opener (Nicorandil) on NHBD. Methods Twenty-four male adult porcine were randomly assigned to two groups: (1) Donor hearts harvested from NHBD in which heart arrest was induced by means of exsanguination (keeping blood pressure at zero for 30 rain, and heart arrest for 9 to 12 min), and donor heart was protected by means of HOE-642/Nicorandil enriched Stanford solution as well as HOE-642/Nicorandil-enriched blood cardioplegia, in addition, HOE-642 was intravenously used before exsanguination and during the initial period of reperfusion (i. e. , after decrossclamping of aorta) (experimental group, n = 6) ; (2) Donor hearts harvested from heart-beating donor (HBD), and protected by clinically used routing method (control group, n = 6). All harvested hearts in both groups underwent a 4 h cold storage, followed by orthotropic heart transplantation. Left ventricular mechanical performance (LVPDP, LVEDP, + dp/dt, -dp/dt), and myocardial water content (MWC) were determined, hearts were also analyzed under the light microscopy or electron microscopy for structural injuries. Results All animals could wean from cardiopulmonary bypass successfully.There were no significant differences between experimental group and control group in left ventricular mechanical performance and MWC (P＞0. 05). There was no serious cell damage when examined under the light and transmission electron microscopy and cardiomyocytes were well preserved in both groups. Conclusion Heart transplantation using NHBD heart could lead to the same encouraging outcome as using HBD heart, and this kind of donor hearts might be an ahernative potential resource of graft for heart transplantation. HOE-642 plus nicorandil is feasible to provide optimal protection for NHBD heart.