本文選題：終末熱灌注　切入點：豬　出處：《鄭州大學》2015年碩士論文

【摘要】：背景與目的目前,世界范圍內終末期心力衰竭患者逐年增多。而終末期心力衰竭可導致患者的生活質量明顯降低,大大縮短患者的壽命。心臟移植手術是目前公認的可以有效治療終末期心臟疾病的首選方案。隨著免疫抑制技術和手術技術的發展,心臟移植手術已經逐步從實驗室轉變為常規的手術治療方法,在臨床中廣泛開展,使越來越多的患者受益。但是我國心臟移植與其他器官的移植一樣,受到各方面因素的制約:一是供體的來源缺乏,傳統習慣的影響,腦死亡后自愿捐獻器官的患者及家屬很少;二是移植手術和術后免疫抑制劑終身治療的費用較為昂貴;三是器官難以合理充分利用,國內還沒有建立起來有組織的全國性移植器官捐獻和分配的網絡。而正因為心臟器官的珍貴,我們對待每一例心臟移植的供體心臟都要小心謹慎,盡可能的保護其功能狀態,使患者更加受益。本研究旨在探索終末熱灌注法對心臟移植供體心臟的保護作用。材料與方法同家系配型成功的瑞典家豬12對,隨機分為兩組,即實驗組與對照組,每組6對。對每一組行原位心臟移植手術。對照組手術完成后正常放開主動脈鉗恢復心臟灌注。實驗組則在開放主動脈前經歷短暫的終末熱灌注再恢復灌注。分別于供體心臟缺血前、恢復灌注5min時、恢復灌注30min時、恢復灌注1h時及恢復灌注2h時五個時間點取冠狀靜脈竇口和主動脈根部血樣進行血氣分析對比血中乳酸含量及氧分壓并監測左右冠狀動脈開口血流量;在恢復灌注時及其后4h、12h、24h分別抽取受體豬頸內動脈血樣送實驗室檢測肌鈣蛋白T(c Tn T)濃度。結果實驗組與對照組在恢復灌注后冠狀動脈血液流量間差異無統計學意義(F組間=2.193,P=0.1730.05)。兩組術后心臟氧利用率,不同時間點心肌乳酸利用量及血漿肌鈣蛋白T濃度均有差異,且差異有統計學意義(F組間=9.041、F時間=44.844和138.908,P0.05),實驗組氧利用率更早恢復正常;在恢復灌注5min時,實驗組心肌乳酸利用量蓄積要低于對照組;在恢復灌注24h時,實驗組血漿肌鈣蛋白T濃度低于對照組(P0.05)。結論心臟移植術中使用終末熱灌注可降低心肌無氧代謝水平,促進了心肌細胞功能恢復,減輕心肌細胞損傷。
[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.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2

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