The Research Of The Protection Effect About The Hormonal Substitute Therapy To The Cardiac Function Of The Brain Death Pigs

Since Doctor Christian Barnard in South Africa did the first human heart transplantation surgery in 1967,the heart transplantion surgery had become one of the methods to treat the final stage heart disease. Recently , the livability after the heart transplant surgery has enhanced greatly because the develop of the heart preservation technology,immune suppression and the skill of the surgery. But the great promble in heart transplantation is the limition of the donor hearts. The precondition of the organ transplant is the suitable donor organs. The donor hearts almost come from brain death donors , so the research of the brain death heart donor is gradually become the hot topic recently. After brain death,the change of the haemodynamcics,neuro effectors and the incretion metabolize would badly affect the heart, especially the change of the incretion system, which attack the heart obviously. All of the changes have tightness relationship with the heart function to the donor of the brain death. Most of the researches now focus on how to preserve the function of ex vivo donor heart ,for example the heart preservative fluid and so on. It has hardly seen the research of how to protect the in vivo brain death donor heart and avoid the bad effect to donor heart from the change about the brain death except to use the thryroxin which has been uncertainly affected. Use the complex hormone to protect the heart function of brain death donor in vivo which is affected by the internal secretion change after the brain death has been hardly seen before.Experiment aimApply the hormone to avoid the bad effect to the donor heart about the brain death, protect the heart function of the donor heart and approach the mechanism of the hormonal substitute therapy.MethodsWe use 35 Sweden pigs with similar weights. 3 for preliminary test .16 pigs for hormonal group and control group ,each group has 8 pigs on random; and another 16 pigs for heart transplant acceptor after blood type zygosity. After construct the brain death model by intracal pressure , we use the Ringer liquor and the lower molecular dextran to maintain the homeostasis in control group and beside these we add AD,NE,T₃,T₄,CORT and ADH in hormonal group. Detect the 24h MAP,CVP,LVEF,total volume of urine and the change of the heart function in the two group at every time point.After 24h, we disclose the thorax of the pigs in the two group which is the heart donors. After heparinization, incide the hearts in the donors and transplant to the acceptors. Detect the 24h MAP,CVP,LVEF in the two group at every time point. At last ,we inject the AD 50μg ,observe the difference of the supply heart function reserve between the two groups.Results1. The MAP of the brain death pigs in control group (64.2±9.33 ) mmHg is obviously lower than the pigs in hormonal group (81.8±6.3) mmHg (P <0.05) after 8h. The LVEF of the brain death pigs in control group (55.2±4.15) % is obviously lower than the pigs in hormonal group (70.0±4.12) % (P <0.05) after 12h. The CVP of the brain death pigs in control group (15.0±2.09) cmH₂O is obviously higher than the pigs in hormonal group (7.7±2.25) cmH₂O (P <0.05) after 24h. And the 24h total volume of urine of the brain death pigs in control group (9.000±1.225)L is obviously higher than the pigs in hormonal group (9.000±1.225)L (P<0.05) .2. After heart transplantation , the MAP of the pigs in control group (57.8±6.50 ) mmHg is obviously lower than the pigs in hormonal group (72.4±6.81) mmHg(P<0.05) after 4h. The LVEF of the pigs in control group (57.0±1.70) % is obviously lower than the pigs in hormonal group (67.6±3.36) % (P<0.05) after 4h. The CVP of the pigs in control group (9.14±0.97) cmH₂O is obviously higher than the pigs in hormonal group (6.64±1.02) cmH₂O (P<0.05) after Oh. After inject the AD 50μg, the MAP of hormonal group is (179.8±19.03) mmHg and the heart rate is (186.4±10.06) /min ,which are obviously higher than the MAP(120.2±8.07) mmHg ,the heart rate (125.0±13.17) /min of the control group, (P <0.05) .Conclusion1. The hormonal substitute therapy can avoid the donor's heart injure which is caused by endocrine system disorder after brain death, and effective protect the function of the heart donor of the brain dead in vivo;2. The donor's heart which were used hormonal substitute therapy can have a better function than the heart which were not used hormonal substitute therapy.