机械胸外按压心肺复苏（MCPR）对供体心脏的影响研究

发布时间：2018-04-19 01:26

本文选题：MCPR + 心肺复苏　；参考：《河南大学》2013年硕士论文

【摘要】：1.背景随着社会发展及经济进步，人们生活水平在不断改善，随之而来的是各种肥胖相关性疾病的增加。其中高血压、冠心病及器质性心脏病的终端治疗措施只有心脏移植。目前常用的供体心脏大多数来自于脑死亡的患者，并且此类患者常伴有人工心肺复苏的应用，但是在进行人工心肺复苏时由于人的易疲劳性等不确定因素可使心脏受损，加上缺血再灌注损伤等因素严重影响了供心的心功能，从而不能作为供体使用。供体心脏如果移植前保护效果好，其心功能能够得到较为完整的保存，这是心脏移植能否成功的前提条件。能够符合条件的供体心脏数量严重影响了心脏移植的进展。如何提供充足的供心，最大限度地保存供心的心功能，一直是广大医疗工作者及科研工作者努力的方向。目前在欧美及我国部分地区开始使用的一种新型设备Lund University CardiacAssist System （LUCAS; Lund, Sweden,自动心脏按压器)，，能自动对停跳后的心脏进行体外不间断按压，实施机械胸外按压心肺复苏术（MCPR），从而能在长途运输中有效地保护脑死亡后供体心脏的功能。本研究通过建立人工心脏按压和应用LUCAS的机械心脏按压模型，对比二者在供体心脏的心功能、内皮细胞功能、心肌细胞凋亡等方面的差异，分析应用LUCAS后对供体心脏的影响。 2.方法将瑞典品种的家猪随机分为人工心脏按压组和机械心脏按压组，每组15头。建立人工心脏骤停后，各组分别进行人工心脏按压(CPR)和应用LUCAS的连续机械心脏按压(MCPR)，成功复苏并离体保存后，检测供体心脏的肺动脉血流、冠状动脉内皮细胞功能等指标，探讨那种方法对供体心脏的保护作用更佳。 3.结果结果表明，使用LUCAS后再保存的供体心脏肺动脉血流量显著优于人工按压后再保存的供体心脏；冠状动脉内皮细胞功能得以最大限度地保护；同时，心肌细胞凋亡水平检测表明，经LUCAS后再保存可以显著减少心肌细胞凋亡，细胞内超氧化物水平显著低于常规保存组。进一步的研究发现，应用LUCAS后再保存的心脏心肌细胞内c-Src活性明显高于对照组。 4.结论这些结果表明经LUCAS处理后的供体心脏，其冠状动脉内皮功能、心功能保存较好，心肌细胞c-Src活性一直处于高水平，可对心肌细胞氧化还原水平进行调控，降低了细胞内超氧化物水平，抑制了心肌细胞的凋亡，最大限度地保护了心功能。提示应用自动心脏按压器能够为心脏移植提供较好的供体条件，进而提供更多的供体来源。
[Abstract]:1.BackgroundWith social development and economic progress, people's living standards are improving, followed by an increase in various obesity related diseases.Heart transplantation is the only terminal therapy for hypertension, coronary heart disease and organic heart disease.Most of the commonly used donor hearts come from patients with brain death, and these patients are often accompanied by artificial cardiopulmonary resuscitation (CPR).Combined with ischemia-reperfusion injury and other factors seriously affect the heart function of the donor, so it can not be used as a donor.If the donor heart has a good protective effect before transplantation, its heart function can be preserved completely, which is the precondition for the success of heart transplantation.The number of eligible donor hearts seriously affects the progress of heart transplantation.How to provide sufficient donor heart and preserve heart function to the maximum extent has been the direction of medical and scientific research workers.At present, a new type of equipment, Lund University CardiacAssist System, LUCAS, Lund, Sweden, automatic cardiac compressors, is used in Europe, America and parts of China.Mechanical cardiopulmonary resuscitation can effectively protect the function of donor heart after brain death.In this study, the effects of LUCAS on donor heart were analyzed by establishing mechanical cardiac compression models of artificial heart compression and LUCAS, and comparing the difference of cardiac function, endothelial cell function and cardiomyocyte apoptosis between the two groups.2.MethodSwedish domestic pigs were randomly divided into artificial cardiac compression group and mechanical cardiac compression group with 15 pigs in each group.After establishing artificial cardiac arrest, each group was subjected to artificial cardiac compression (CPR) and continuous mechanical cardiac compression (LUCAS) respectively. After successful resuscitation and preservation in vitro, the pulmonary artery blood flow and endothelial cell function of coronary artery were measured.It is better to explore the protective effect of that method on donor heart.3.ResultThe results showed that the pulmonary artery blood flow of donor heart after LUCAS was significantly better than that of donor heart after artificial compression, the function of coronary artery endothelial cells was protected to the maximum extent, and the level of cardiomyocyte apoptosis was detected.After LUCAS preservation, myocardial apoptosis was significantly reduced, and the intracellular superoxide level was significantly lower than that in the conventional preservation group.Further studies showed that the activity of c-Src in cardiac myocytes after LUCAS was significantly higher than that in control group.4.ConclusionThese results suggest that the coronary artery endothelial function and cardiac function of donor heart treated with LUCAS are well preserved, and the activity of c-Src in cardiac myocytes is always at a high level, which can regulate the redox level of cardiomyocytes.It can reduce the level of superoxide, inhibit the apoptosis of cardiomyocytes, and protect cardiac function to the maximum extent.It is suggested that the application of automatic cardiac compressors can provide better donor condition for heart transplantation and provide more donor sources.
【学位授予单位】：河南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7

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