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体外循环条件下(降温130℃,平均经历81分钟)逆灌冷钾氧合稀释血(4℃)实施瓣膜置换术中,应用焦锑酸钾示踪法作为钙探剂对10例风心病患者左心房肌线粒体做了动态定量研究。结果表明,线粒体结构变化极轻,主要病变是膜通透性增高和钙超载。其钙高峰出现于时相Ⅱ,含钙线粒体及所含钙粒的体密度分别增大13倍和5倍。这与顺灌钙高峰的水平相一致,但较顺灌提前一个时相发生,显示逆灌能使心肌组织获得更充分的灌注。第2个钙高峰出现于时相Ⅲ,其水平高于时相Ⅱ,但无统计学意义,到时相Ⅳ则急剧下降。其发生可能与复流再灌有关,但不伴有结构损伤。这说明逆灌的保护效果优于顺灌,能进一步降低受累心脏对缺血的敏感性。估计其最大耐受时间可达100分钟,体外循环的最佳时间为40~70分钟。
Under the condition of cardiopulmonary bypass (cooling 130 ° C, average 81 minutes), the patients were treated with valvuloplasty (4 ℃) Left atrial muscle mitochondria made a dynamic quantitative study. The results showed that mitochondrial structure changes very light, the main disease is increased membrane permeability and calcium overload. The calcium peak appears in Phase II, and the body density of calcium-containing mitochondria and calcium-containing particles increases by 13-fold and 5-fold, respectively. This coincides with the level of cis-acting calcium peak, but compared with cis-acting in one phase in advance, suggesting that instillation can make myocardial tissue obtain more adequate perfusion. The second calcium peak appeared in phase Ⅲ, its level is higher than that of phase Ⅱ, but it is not statistically significant, and the phase Ⅳ decreases sharply. Its occurrence may be associated with reperfusion irrigation, but not associated with structural damage. This shows that the protection effect of inverse irrigation is better than irrigation, can further reduce the sensitivity of the affected heart to ischemia. It is estimated that the maximum tolerated time of up to 100 minutes, the best time for cardiopulmonary bypass 40 to 70 minutes.