氧合温血停搏液诱导及／或末次灌注在心肌保护中的临床应用

Clinical Practice of Oxygenated Warm Blood Induced Cardioplegic Solution and/or Last Perfusion in Myocardium Protection

随机选１３０例体外循环（ＣＰＢ）心内直视手术病人分为温血灌注组简称Ａ组（ｎ＝７５例）和非温血灌注组简称Ｂ组（ｎ＝５５例），两组病人性别、血液稀释度及使用的氧合器种类均无差异（Ｐ＞０．０５），转流后、复温后由ＣＰＢ系统中的动脉微栓过滤器排气端分出所需温血量（５～１０ｍｌ／ｋｇ），加入配方中的药量，利用加压驱动装置行升主动脉根部灌注。术后Ａ组的平均转机时间及阻断主动脉时间明显长于Ｂ组；Ａ组的自动复跳率明显高于Ｂ组；Ａ组的低心排征及死亡率明显低于Ｂ组，说明温血对心肌有优越的保护作用。但同时我们也发现温血诱导灌注可使心脏在阻断主动脉后的停跳时限延长，这不利于心肌保护，其原因有待进一步探讨。

130 cases of openheart operation throtigh extracorporeal circulation were selected byrandom and divided into two groups,warm blood groLip(A=75)and no warm blood group(B=55).There was no significant difference between two groups on age,blood dilution andtype of oxygei1ator(P>0.05), We acquired the warm blood(5～10 ml/kg) from arterial micro-embolism filter of extracorporeal circulation system after rewarming and then mixed itwith cold cardioplegic solution,perfusion was through aortic root.Average bypass time and aortic clamping time of group A were predominantly longer than that of group B after operation.Selfheart resuscitation rate of group A was evidently higher than that of group B.Mobidity of low-cardial output and mortality of group A were significantly lower than that ofgrotip B, It indicated that warm blood played a role in myocardium protection, but at the sametime it was also found that warm blood-induced perhsion elongated the time of arrest afterclamping aorta. It is disadvantageous to myocardium protection.Its mechanism needs to bestudied further.