ACCELERATED MYOCARDIAL METABOLIC AND FUNCTIONAL RECOVERY WITH TERMINAL NICORANDIL-MG CARDIOPLEGIA IN HEART-TRANSPLANTATION

被引：2

作者：

ORITA, H

SHIMANUKI, T

FUKASAWA, M

ABE, H

KURAOKA, S

HIROOKA, S

WASHIO, M

机构：

[1] Second Department of Surgery, Yamagata University School of Medicine, Yamagata City, 990-23, Iida-Nishi

来源：

CARDIOVASCULAR DRUGS AND THERAPY | 1991年 / 5卷 / 04期

关键词：

TERMINAL CARDIOPLEGIA; REPERFUSION INJURY; NICORANDIL;

D O I：

10.1007/BF03029747

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Cardiac reperfusion injury after heart transplantation or cardiopulmonary bypass has been difficult to control due to the variable degree of myocardial damage with respect to the length of ischemia and the complexity of the surgical procedure. Here, we evaluated the myocardial metabolic and functional recovery of hearts infused with a nicorandil vasodilator-magnesium (Mg) solution just prior to reperfusion (terminal cardioplegia). Donor hearts (20 dogs) were removed and immersed in a 4-degrees-C water bath containing 20 mEq/l KCL-5% glucose for 6 hours, and then were transplanted to recipient dogs. Orthotopically transplanted dog hearts were either reperfused without any further treatment or received a terminal cardioplegic solution containing 8 mg/l nicorandil, 30 mEq/l Mg, and 50 g/l glucose, which was infused at a pressure of 75 cm H2O for 2 minutes. During the reperfusion period, myocardial tissue PCO2 (t-PCO2) and calcium ion (t-Ca) were continuously monitored by an ISFET (ion-sensitive field effect transistor) sensor. Myocardial oxygen consumption and lactate flux were calculated/monitored at 5, 10, 20, and 40 minutes of reperfusion. Thereafter, myocardial function was evaluated at 45 minutes of reperfusion using LVSWI. Just after reperfusion, the treatment group (group B, n = 10) had a significantly greater coronary flow than the control group (Group A, n = 10, 35.0 +/- 10.1; group B, 47.4 +/- 8.5 ml/100 g/min, p < 0.025). Myocardial tissue PCO2 and calcium ion levels in group B were significantly decreased at 5 minutes of reperfusion (A: 110 +/- 21 --> 88 +/-16; B: 126 +/- 24 mmHg --> 44 +/- 7 mmHg, t-PCO2, p < 0.001; A: 3.5 +/- 0.7 --> 3.2 +/- 0.7; B: 2.7 +/- 0.7 mM --> 1.7 +/- 0.6 mM, t-Ca, p < 0.001). Also, group B had better metabolic recovery, as evaluated by increased myocardial oxygen consumption and increased lactate flux. Thus, terminal nicorandil-Mg cardioplegia improved myocardial blood flow, which in turn markedly improved tissue acidosis, thereby reducing the extent of reperfusion injury.

引用

页码：727 / 732

页数：6

共 22 条

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