终末热灌注对心脏移植手术中供体心脏的保护作用

发布时间：2018-04-04 00:17

本文选题：终末热灌注　切入点：猪　出处：《郑州大学》2015年硕士论文

【摘要】：背景与目的目前,世界范围内终末期心力衰竭患者逐年增多。而终末期心力衰竭可导致患者的生活质量明显降低,大大缩短患者的寿命。心脏移植手术是目前公认的可以有效治疗终末期心脏疾病的首选方案。随着免疫抑制技术和手术技术的发展,心脏移植手术已经逐步从实验室转变为常规的手术治疗方法,在临床中广泛开展,使越来越多的患者受益。但是我国心脏移植与其他器官的移植一样,受到各方面因素的制约:一是供体的来源缺乏,传统习惯的影响,脑死亡后自愿捐献器官的患者及家属很少;二是移植手术和术后免疫抑制剂终身治疗的费用较为昂贵;三是器官难以合理充分利用,国内还没有建立起来有组织的全国性移植器官捐献和分配的网络。而正因为心脏器官的珍贵,我们对待每一例心脏移植的供体心脏都要小心谨慎,尽可能的保护其功能状态,使患者更加受益。本研究旨在探索终末热灌注法对心脏移植供体心脏的保护作用。材料与方法同家系配型成功的瑞典家猪12对,随机分为两组,即实验组与对照组,每组6对。对每一组行原位心脏移植手术。对照组手术完成后正常放开主动脉钳恢复心脏灌注。实验组则在开放主动脉前经历短暂的终末热灌注再恢复灌注。分别于供体心脏缺血前、恢复灌注5min时、恢复灌注30min时、恢复灌注1h时及恢复灌注2h时五个时间点取冠状静脉窦口和主动脉根部血样进行血气分析对比血中乳酸含量及氧分压并监测左右冠状动脉开口血流量;在恢复灌注时及其后4h、12h、24h分别抽取受体猪颈内动脉血样送实验室检测肌钙蛋白T(c Tn T)浓度。结果实验组与对照组在恢复灌注后冠状动脉血液流量间差异无统计学意义(F组间=2.193,P=0.1730.05)。两组术后心脏氧利用率,不同时间点心肌乳酸利用量及血浆肌钙蛋白T浓度均有差异,且差异有统计学意义(F组间=9.041、F时间=44.844和138.908,P0.05),实验组氧利用率更早恢复正常;在恢复灌注5min时,实验组心肌乳酸利用量蓄积要低于对照组;在恢复灌注24h时,实验组血浆肌钙蛋白T浓度低于对照组(P0.05)。结论心脏移植术中使用终末热灌注可降低心肌无氧代谢水平,促进了心肌细胞功能恢复,减轻心肌细胞损伤。
[Abstract]:Background & objective at present, the number of patients with end-stage heart failure is increasing year by year worldwide.End-stage heart failure can lead to a significant decline in the quality of life, significantly reducing the life expectancy of patients.Heart transplantation is currently recognized as the first choice for the effective treatment of end-stage heart disease.With the development of immunosuppressive and surgical techniques, heart transplantation has been gradually changed from laboratory to conventional surgical treatment, widely carried out in clinical practice, benefiting more and more patients.However, the heart transplantation in our country, like other organs transplantation, is restricted by various factors: first, lack of donor sources, the influence of traditional habits, the number of patients and their families who donate organs voluntarily after brain death is very few;The second is that the cost of transplantation surgery and post-operation immunosuppressive life-long treatment is more expensive; the third is that it is difficult to make full use of the organs and there is no organized national network of organ donation and distribution in China.Because of the precious heart organ, we should take care to protect the function of the donor heart in every case of heart transplantation, so that the patients can benefit more.The purpose of this study was to explore the protective effect of end-end heat perfusion on donor heart transplantation.Materials and methods 12 pairs of Swedish pigs were randomly divided into two groups: experimental group and control group, 6 pairs in each group.Orthotopic heart transplantation was performed in each group.In the control group, normal release of aortic forceps restored cardiac perfusion after operation.The experimental group underwent a short period of final heat perfusion and reperfusion before opening the aorta.Before ischemia, when the donor heart was perfused with 5min, and when the donor heart was perfused with 30min,Blood samples of coronary sinus orifice and root of aorta were collected at 1 h after reperfusion and 2 h after reperfusion. Blood gas analysis was performed to compare the content of lactic acid and partial pressure of oxygen in blood and to monitor the blood flow of left and right coronary artery orifice.The blood samples of the recipient pig internal carotid artery were collected at the time of recovery of perfusion and at 4 h and 12 h for 24 h, respectively. The concentration of troponin TnTn was detected in the laboratory.Results there was no significant difference in coronary artery blood flow between the experimental group and the control group after reperfusion.There were significant differences in cardiac oxygen utilization rate, myocardial lactate utilization rate and plasma troponin T concentration at different time points between the two groups, and the difference was statistically significant between F group (P < 0.05) and F group (P < 0.05). The oxygen utilization rate of the experimental group returned to normal earlier than that of the control group (P < 0.05).The accumulation of lactate in the experimental group was lower than that in the control group, and the plasma troponin T concentration in the experimental group was lower than that in the control group at 24 h after reperfusion.Conclusion End-end heat perfusion during cardiac transplantation can reduce myocardial anaerobic metabolism, promote myocardial function recovery and alleviate myocardial cell injury.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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