浅低温体外循环心脏不停跳下心内直视术临床分析

Clinical analysis of open heart surgery on beating heart under cardiopulmonary bypass and mild hypothermia

目的 通过测定心脏不停跳与心脏停跳手术两组患者的血浆肌钙蛋白 ( c Tn- )值 ,评价心脏不停跳手术对心肌保护的效果。方法 随机选择 2 0例先天性心脏病患者于浅低温体外循环下施行心脏不停跳心内直视手术作为实验组 ,同期随机选择 2 0例施行常规心脏停跳心内直视手术作为对照组 ,测定两组患者术前、术中、术后各时相的血浆 c Tn- 值进行比较研究。结果 两组术前 c Tn- 值差异无显著性 ,转机后两组 c Tn - 值均升高 ,对照组比实验组增高明显 ,差异有显著性 ( P<0 .0 5)。结论 浅低温体外循环心脏不停跳手术可明显减轻心肌缺血再灌注损伤 ,对心肌起到良好的保护作用。

Objective Comparatively detecting the cardiac troponin Ⅰ (cTn Ⅰ) under beating heart or rested heart,to evaluate the myocardial protective effect of beating heart operation.Methods Forty patients were randomly divided into two groups.Twenty patients were in the beating group,others were in the rested group.The cTn Ⅰ values were determined before the operation,during the operation,and immediately after cardiopulmonary bypass (CPB),as well as 3 h,6 h,24 h and 48 h after heart operation.Results cTn Ⅰ level was the same in two groups before operation.cTn Ⅰ level increased in both groups,but was significantly lower in the beating group than that in the rested group at each time point (P<0 05).Conclusion Hypothermic cardiac operation while heart beating can obviously reduce myocardial ischemia and reperfusion injury,giving a good protective action to the heart muscle.