冷晶体停搏液与综合应用血液停搏液灌注在心脏瓣膜置换术中心肌保护作用的对比研究

The Comparison Study of Cold Crystalloid Cardioplegia and Comprehensive Application Blood Cardioplegla on Myocardial Protection in Cardiac Valve Replacement Operations

目的对比研究冷晶体停搏液与综合应用血液停搏液灌注在心脏瓣膜置换术中的心肌保护作用。方法选择心脏瓣膜置换术患者23例,随机分为冷晶体停搏液组(CCC组)11例和血液停搏液组(BCP组)12例进行心肌保护的临床对比观察。术中CCC组采用冷晶体心脏停搏液间断灌注,BCP组先灌注高钾温血停搏液诱导心脏停跳,然后间断灌注冷血心脏停搏液,手术终末主动脉开放前温血诱导心脏复跳。结果CCC组自动复跳率低于BCP组(P<0·05),术后室性心律失常发生率多于BCP组(P<0·05),术后呼吸机辅助呼吸时间和术后强心利尿剂及正性肌力药物的用量、应用时间、应用率均多于BCP组(P<0·05),在升主动脉开放后各个时相点血cTnI高于BCP组(P<0·05)。结论综合应用温血心脏停搏液诱导心脏停跳,冷血停搏液间断灌注及终末温血灌注,较冷晶体停搏液间断灌注有更好的心肌保护效果。

Objective To research the myocardial protection effect of cold crystalloid cardioplegia （CCC） and comprehensive application blood cardioplegia （BCP） in cardiac valve replacement operations. Methods 23 patients cardiac valve replacement operations were divided into two groups randomly, We compared the myocardial protection effect in CCC （ n = 11 ） and BCP （n = 12 ）. In operation, CCC group receive intermittent cold crystalloid cardioplegia and BCP group receive first warmed BCP to make heart stop, then intermittent cold blood cardioplegia, finally warmed blood of patients themthelves before aortic cross - clamp release. Results In contrast with patients in CCC group, those in BCP group had a higher rate postoperative spontaneous cardiac rhythm recovery （ P 〈0. 05 ）, and less dependency on respiratory and circulatory support and postoperative ventricular arrhythmia （ P 〈 0.05 ）, as well as lower blood cTnI concentration at every time point after aortic cross - clamp release （ P 〈 0. 05 ）. Conclusion Comprehensive application warmed blood cardioplegia to make heart stop and intermittent cold blood cardioplegia and final warmed blood perfusion have better myocardial protection effect than intermittent cold crystalloid cardioplegia perfusion.