Postischemic Reperfusion Injury Can Be Attenuated by Oxygen Tension Control
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概要
- 論文の詳細を見る
Oxygen-derived free radicals cause cytotoxic damage during reperfusion after a period of ischemia and the production of these free radicals may be proportionate to oxygen tension (PO_2). The present study tested the hypothesis that oxidative damage may be limited by maintaining a more physiologic PO_2 following ischemia. An experimental study in Wistar rats were mounted on a Langendorff apparatus was conducted to estimate baseline aortic flow (AF), coronary flow (CF), cardiac output (CO), systolic pressure (SP), heart rate (HR), and the rate-pressure product (RPP: HR×SP). The hearts were divided into 3 groups (n=7, hearts/group): group 1, hypoxic (PO_2=300±50mmHg) reperfusion; group 2, middleoxic (PO_2=500±50mmHg) reperfusion; and group 3, hyperoxic (PC_2=700±50mmHg) reperfusion. Following 30 min of warm ischemia, hearts in all groups were reperfused at each oxygen pressure. The recovery of cardiac function of each heart was measured at the end of reperfusion. Concentrations of lactate (LAC), lactate dehydrogenase (LDH), and creatine kinase (CK) in the coronary perfusate during reperfusion were measured. The recovery rate of CO, SP, and RPP in group 2 were all significantly better than in the other 2 groups. CK leakage in group 2 was significantly lower than in group 3. A clinical study was also conducted during elective coronary artery bypass grafts in 16 consecutive patients who underwent either hyperoxic (n=8, PO_2=450-550mmHg) or more physiologic (n=8, PO_2=200-250mmHg) cardiopulmonary bypass after aortic unclamping. The clinical study assessed CK-MB, LDH, LAC, and malondialdehyde (MDA) in patient blood prior to starting the surgical procedure and at 30 min and 3, 9, and 21h after unclamping. Cardiac index (CI), central venous pressure, pulmonary capillary wedge pressure, systolic arterial pressure, and the dose of cathecholamines were also measured. Although no significant differences were present in the dose of cathecholamines, the CI in the more physiologic oxygen tension group was significantly higher than in the hyperoxic group at 3 and 6h after unclamping. The levels of MDA in the more physiologic PO_2 group was significantly lower at 30 min after aortic unclamping than in the hyperoxic group. The present results suggest that in the experimental as well as in the clinical study, high PO_2 leads to myocardial reperfusion damage; however, maintaining a more physiologic PO_2 during reperfusion following ischemia may attenuate reperfusion injury.
- 社団法人日本循環器学会の論文
- 2001-02-20
著者
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INOUE Takehiro
Department of Radiation Oncology, Osaka University Graduate School of Medicine
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KU Kwansong
Department of Gastroenterology, Kobe Asahi Hospital
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KANEDA Toshio
Department of Pathophysiology, Faculty of Pharmaceutical Sciences, Hoshi University
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Inoue Takehiro
Department Of Cardiovascular Surgery Kinki University School Of Medicine
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ONOE Masahiko
Department of Cardiovascular Surgery, Kinki University School of Medicine
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OKU HIDETAKA
Department of Cardiovascular Surgery, Kinki University School of Medicine
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Inoue Takehiro
Department Of Cardiac Surgery Kinki University Of Medicine
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Inoue T
Department Of Cardiovascular Surgery Kinki University School Of Medicine
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Ku Kwansong
Department Of Cardiovascular Surgery Kinki University School Of Medicine
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Oku Hidetaka
Department Of Cardiac Surgery
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Oku Hidetaka
Hyogo Kenritsu Amagasaki Hospital Division Of Cardiovascular Surgery
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Oku Hidetaka
The Department Of Cardiovascular Surger Kinki University School Of Medicine
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Otaki Masaki
Department Of Cardiovascular Surgery Kinki University School Of Medicine
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Kaneda Toshio
Department Of Cardiovascular Surgery Kinki University School Of Medicine
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Kaneda Toshio
Department Of Cardiovascular Medicine Hanwa Senboku Hospital
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