摘要
作者在实验研究的基础上，选择了临床资料相近的心脏瓣膜病患者２０例，根据术中使用心脏停搏液不同，随机分为２组：①冷氧合血间歇灌注组（ｎ＝１０）；②持续温血停搏液组（ｎ＝１０）．观察了心肌能量代谢变化及血浆磷酸肌酸激酶同工酶（ＣＰＫ－ＭＢ）的改变；同时亦进行了临床资料观察．结果：①冷血组ＣＰＫ－ＭＢ变化于手术结束后开始明显升高，术后１８ｈ达高峰。温血组术后各期酶学指标与冷血组相比均明显降低（Ｐ＜０．０１）．②心肌能量代谢变化：冷血组缺血未ＡＴＰ，总腺苷酸（ＡＮ）含量及ＡＴＰ／ＡＤＰ比值分别下降至停搏前的０．５０±０．１８；０．５８±０．１６和０．５９±０．１８，明显低于温血组的０．８７±０．２３；０．９２±０．１９和０．８６±０．２２．③临床资料观察：温血组的自动复跳率及术后血管活性药物使用率优于冷血组，结论：持续灌注温血停搏技术可以充分保证心肌在常温停跳时的氧供，保存和增加心肌能量的储备，避免了心肌缺血缺氧期，是一种理想的心肌保护法．
In the present study, the patients,
who had undergone the
operation with the approach similar tothat of artificial valve
replacement, were selected and
devided into 2 groups: Group Ⅰ(CBC group):cold in-termittent blood
cardioplegia group and
Group Ⅱ(WBC group):warm continuous blood cardioplegia group. The
changes of CPK- MB
level and myocardial energy metabolism were measured during open-
heart surgeryand the
observation of cardiac resuscitution was undertaken at the same time.
Results showed:(1) In
theCBC group, CPK- MB in plasma remarkedly rose at the end of
operation and reachea the
peak value 18 h afteroperation. In the WBC group, CPK- MB remarkedly
decreased compared
with CBC group(P<0.01).(2) Atthe end of ischemia,ATP, AN and ATP/ ADP
ratios in group CBC,
expressed as percent of value of preis-chemia50±0.16 and 0.59±0.18
respectively(WBC:
0.87±0.23;0.92±0.19 and 0.86±.22).(2)Automatic resuscitation rate
and use rate of position
inotropic were better in WBC group than in CBC group.The results
suggest that warm
continuous blood perfusion could supply sufficient oxygen to
myocardium dur-ing heart arrest,
preserve high-energy phosphates and reduce myocardial injury.
Continuous
normothermicblood cardioplegia is an ideal way of myocardial
preservation.
出处
《第四军医大学学报》
1995年第5期342-344,共3页
Journal of the Fourth Military Medical University
