不同温度含血心肌保护液的临床应用研究

The clinical study on the effect of myocardial protection of blood cardioplegia with different temperature

目的：比较不同温度含血心肌保护液的心肌保护效果。方法：对２０例行心脏瓣膜替换术的患者以不同温度含血心肌保护液进行灌注，组１为深低温组（灌注液温度为１５℃～２０℃）、组２为中度低温组（温度为２５℃～２９℃），监测动、静脉血气分析，计算氧摄取率，测定心肌肌酸激酶（ＣＫ），观察血流动力学变化，对心肌行病理学检查。结果：两组在手术中心脏停跳良好，血流动力学指标无明显差异，但中度低温组患者的心率及中心静脉压较深低温组于停机后保持良好的水平。心肌氧摄取率相同。ＣＫ在，深低温组冠状动脉血流恢复２ｈ后明显增高（６２０±２８）ＵＩ／Ｌ，４ｈ达高峰（９３０±４０）ＵＩ／Ｌ，２４ｈ仍很高（７４０±４７）ＵＩ／Ｌ，中度低温组有相似的变化趋势，但与深低温组比较２４ｈ已明显降低（Ｐ＜０．０５）。病理检查可见深低温组右心房心肌线粒体和肌丝的超微结构有明显损害，中度低温组其变化相对较轻。中度低温组心脏自动复跳率为６６．３％，明显高于深低温组（４８．７％）（Ｐ＜０．０５）。结论：采用中度低温血灌注的心肌保护方法，可同时避免深低温及温血灌注的缺点，有利于更好地保护心肌。

Objective: Twenty patients undergoing cardiac valve replacement were selected for comparing the effect of myocardial protection of blood cardioplegia with different temperature used in cardiopulmonary bypass (CPB). Methods: The patients were divided into deep hypothermic group (the temperature of perfusion sulfate was 15℃～20℃) and moderate hypothermic group(the temperature of perfusion sulfate was 25℃～29℃). Serum creatine kinase(CK) was measured, arteriousvenous blood gas was analysed and oxygen uptaking was calculated. The changes of hemodynamic parameters were recorded and myocardial biopsy was taken. Results: Mild hypothermic group kept better level in HR and CVP after CPB had been stopped. Deep hypothermic group: CK was apparently higher (620±28 UI/L) after the coronary artery was reperfused for 2 h, reached to peak(930±40) UI/L at 4 h and remained at high level (740±47 UI/L) at 24 h; Mild hypothermic group: The change of CK was similar to the deep hypothermic group, but after reperfusion for 24 h its level was lower than that in deep hypothermic group (P<0.05), Pathological examination showed the mitochondria and myofilament were destroyed more severely in deep hypothermia group than that in moderate hypothermia group. The heart automation revival rate in moderate hypothermia group was higher than that in deep hypothermia group (66.3% vs 48.7%,P<0.05). Conclusion: Perfusion with moderate hypothermia cardioplegia is a better method for the protection of myocardium.