温氧合血心麻液连灌在法乐氏四联症术中应用

Continuous application of warm oxygenated blood cardioplegia in surgery for tetralogy of Fallot

为了保证体外循环中心脏的血液供应，减少或避免低温对心肌的损害及缺血再灌注损伤，采用温氧合血心麻液持续灌注＋自体温血终末期灌注心肌保护的方法施法乐氏四联症根治术２３例。结果：心脏停搏迅速可靠且无室颤发生；心内操作完成、开放主动脉后心脏自动复跳率为９１．３％；术后死于心包填塞１例，死亡率为４．４％；无低心排、心律失常、心脏传导阻滞等并发症。心肌酶学检查示术中ＣＫ－ＭＢ轻至中度升高；心肌细胞超微结构检查示体外循环前后无显著改变；转流中血清钾为３．８～５．４ｍｍｏｌ／Ｌ．提示：该心肌保护方法保证了心脏停博期间的血液供应；避免了低温对机体和心肌的损害及心肌缺血的再灌注损伤；其方法安全、简单、可靠。

In order to improve blood supply for heart,decrease or avoid myocardial damage due to hypothermia and ischemic-reperfusion injury during extracorporeal circulation(ECC), continuous perfusion of warm oxygenated blood cardioplegia combined with terminal warm blood was used in the radical operations on 23 cases of tetralogy of Fallot. Cardiac arrest was rapid and reliable without ventricular fibrillation. Spontaneous resuscitation occurred in all patients. The rate of immediate return of sinus rhythm right after removing of the aortic cross clumping was 91.3%. One case died of acute cardiac tamponade after operation. The death rate was 4.4%. No low cardiac output symptoms, severe arrhythmias and conduction abnormalities were observed after operation. Serum myocardial enzyme level(CK-MB) had a mild or moderate rise and the amount of serum K+ was 3.8～5.4mmol/L during ECC. The myocardial ultrastructure had no marked changes before or after ECC. The results demonstrate that continuous warm oxygenated blood cardioplegia can avoid many side effects of cold cardioplegia and ischemic-reperfusion injury. It is a safe, simple and reliable measure for myocardial protection.