诱导性室颤法在二尖瓣置换术中的心肌保护作用

Myocardial protection of induced ventricular fibrillation for mitral valve replacement

目的探讨诱导性室颤状态下行体外循环二尖瓣置换术的心肌保护效果。方法对照分析诱导室颤组(VF组,15例)和冷晶体停跳液组(CC组,15例)围手术期心肌肌钙蛋白(cTnI)、磷酸肌酸激酶同工酶(CK-MB)、脂质过氧化物产物丙二醛(MDA)和超氧化物歧化酶(SOD)的血清浓度变化。结果两组术后血清cTnI,CK-MB,MDA和SOD水平均不同程度升高,CC组的cTnI,CK-MB在术后各时点均高于VF组(P<0.01),MDA值在心脏恢复搏动后6、24 h,SOD值在2 h分别高于VF组(P<0.05)。cTnI值在恢复心搏后12 h、CK-MB值和MDA值在6 h、SOD值在2 h分别达高峰。除SOD外,其余指标值在48 h仍高于术前。结论诱导性室颤法可明显减轻心肌缺血、缺氧及再灌注损伤,有较好的心肌保护效果。

Objective To explore the effects of using induced ventrieular fibrillation technique for mitral valve replacement on myocardial protection. Methods There were 30 patients with acquired cardiac valscular disease mitral stenosis who received the cardiac surgery procedures first. The patients were randomly divided into two groups equally： control group experienced cold erystalloid cardioplegia （CC, n = 15） and experimental group received induced ventrieular fibrillation with no aortic cross-clamping（ VF, n = 15）. Serum Cardiac troponin I （eTnI）, Creatine kinase MB （CK-MB）, malonyldialdehyde （MDA） and superoide dismutase （SOD） were measured. Results All serum enzymes increased in groups VF and CC postoperatively. The serum lever of eTnI and CK-MB were significantly lower in group VF than in group CC （P 〈 0.01 ）. Conclusion The induced ventrieular fibrillation technique can supply continually oxygen and blood to myocardium and reduce ischemie-reperfusion injury. So it is a good way of myocardial protection in cardiac surgery.