体外循环下不停跳及持续逆灌心肌保护效果临床研究

Myocardial Protection Under Continuous Retrograde Perfusion in Extracorporeal Circulation

目的评价浅低温心脏不停跳及中低温室颤性停搏下心内直视手术对心肌保护的效果。方法常规建立体外循环,转机后阻断上、下腔静脉并降温,不阻断升主动脉(如手术位于主动脉根部的成人患者,则阻断升主动脉并经冠状静脉窦持续逆行灌注),不使用心脏停搏液。浅低温心脏不停跳组鼻咽温度控制在(32±1)℃、中低温室颤性停搏组鼻咽温度控制在27～28℃下行心内直视手术。中低温组的病例在鼻咽温度降至30～27℃的范围内出现室颤性停搏。结果两组术中转机时间、术后呼吸机辅助时间、强心药物的使用及心律失常的发生情况等在统计学上均无显著性差异。结论浅低温心脏不停跳及中低温室颤性停搏下心内直视手术都具有较好的心肌保护效果,但中低温下手术更有利于心内的操作。

OBJECTIVE To access the effect of using moderate hypothermic beating - heart and mild hypothermic ventricular fibrillation for myocardial protection in open heart surgery. METHODS Two hundred and sixty three patients were randomized to the group of using moderate hypothermic beating- heart （n = 94） and the group of mild hypothermic ventricular fibrillation （n = 169）. In the first group, patients underwent moderate hypothermic （32±1℃ ） beating - heart operations. In the second group, patients underwent mild hypothermic （27 ～28℃） ventricular fibrillation operations, and ventricular fibrillation occurs when the temperature descended to 30～27℃. RESULTS There are 4 death cases in moderate hypothermic beating - heart group and 3 death cases in mild hypothermic ventricular fibrillation group. It was no significant difference in the time of cardiopulmonary bypass ,assisted ventilation and arrhythmia between the two groups. There are 56 patients needn1 blood transfusion（21.29% ）. There is no gas embolism. CONCLUSION Both these techniques are good effect for myocardial protection. But it＇s beneficial for operation by mild hypothermic ventricular fibrillation. And it is a safe and effective technique applied to myocardial protection.