低温体外循环下阻断及不阻断升主动脉行心内直视手术的临床研究

Clinical study of heart operation under extracorporeal circulation with hypothermia

目的评价体外循环室颤下心内直视手术的临床应用价值。方法57例先天性心脏病患者,随机选择分为实验组(室颤组,n=31)和对照组(停跳组,n=26)。术中分别测定室颤前及复跳后冠状静脉窦处血液的心肌磷酸肌酶同工酶(CPK-MB)、心肌肌钙蛋白I(CTnI)、乳酸脱氢酶(LDH)。术后观察心功能及神志、血红蛋白尿等并发症发生率。结果复跳后2组CPK-MB、LDH、CTnI较室颤前均增高(P<0.05),但对照组比室颤组升高更明显(P<0.01)。且术后对照组使用多巴胺的例数比实验组高出近1倍。实验组有3例出现血红蛋白尿。结论体外循环低温室颤下心内直视手术比传统心脏停跳下手术的心肌保护效果佳。可应用于大部分无主动脉瓣病变的心内直视手术。

Objective To evaluate the clinical value of open heart operation with ventricular fibrillation under extracorporeal circulation. Methods Fifty-seven patients with congenital heart disease were randomly divided into experimental group （ operation under ventricular fibrillation, n = 31 ） and control group （ operation without heartbeat, n = 26）. The levels of creatine phosphokinas-MB （ CPK-MB）, cardiac troponin Ⅰ （ CTnⅠ）, lactate dehydrogenase （LDH） in coronary vein sinus were determined before ventricular fibrillation and after heartbeat recovered, The changes of heart function, mind and the incidence of complications such as hemoglobinuria were also observed. Results The levels of CPK-MB, LDH and CTn Ⅰ were all increased after heartbeat recovered in both groups （ P 〈 0. 05 ） , but the changes in control group were more significant than those in experimental group （ P 〈 0. 01 ）, The amount of patients who needed dopamine in experimental group was one time higher than that of the control group. There were three patients with hemoglobinuria in experimental group, without significant difference with those of the control group（ P 〉 0. 05 ）. Conclusion The open heart operation with ventrieular fibrillation due to hypothermia is more effective than traditional open heart operation without heartbeat, and can be used in most open heart operation without aortic valve process.