温血持续灌注心肌保护对心肌酶和超微结构的影响

Influence of continuous warm blood cardioplegias in myocardial protection to cardiac enzyme and ultrastructure.

目的 观察含钾温氧合血持续和冷氧合血间歇灌注心肌保护方法应用于先天性心脏病直视手术的疗效。方法 室间隔缺损20例随机分为含钾温氧合血持续灌注组（温血组）与含钾冷氧合血间歇灌注（冷血组），每组各10例，检测体外循环前、再灌注即刻、再灌注后6h、再灌注后24h外周静脉血肌酸激酶（CK）、肌酸激酶同工酶（CK．MB）；主动脉阻断即刻与开放主动脉前分别取房间隔组织，用透射电子显微镜观察心肌超微结构变化。结果 两组再灌注后各时点外周静脉血CK、CK-MB温血组较冷血组低（P〈0．05）；温血组心肌细胞超微结构改变轻微。结论 含钾温氧合血持续灌注心肌保护明显减轻心肌缺血再灌注损伤，应用于先天性心脏病直视手术显示优越的心肌保护作用。

Objective To observe the therapeutic effect of continuous warm potassium containing blood cardioplegia（ warm group） and intermittent cold blood eardioplegia（ cold group） in open heart surgery. Methods Twenty cases of interventrieular septal defect were randomly divided into continuous warm potassium containing blood cardioplegia （warm group ） and intermittent cold blood cardioplegial cold group ） （n = 10 for each ）. Peripheral venous blood creatine kinase （ CK ） and MB isoenzyme of creatine kinase （ CK-MB ） in each group were measured before extracorporeal circulation, immediately on reperfusion, 6 h and 24 h after reperfusion. Transmission electron microscope was used to observe the myocardial ultrastrueture by taking use of atrial septal tissue adopted immediately when the aorta was blocked and before the aorta was opened. Results CK and CK-MB in warm group were lower than in cold group at each time point of reperfusion （ P 〈 0. 05 ） and the myocardial ultrastructure of warm group was sligtly changed. Conclusion Continuous warm potassium containing blood cardioplegia can apparently palliate the reperfusion injury of myocardial ischemia, which is superior in myocardial protection under open heart surgery.