终末温血低钾停搏液再灌注技术在心脏瓣膜置换术中的应用

Application of terminal warm blood hypokalemia cardioplegia reperfusion in operation of valve replacement

目的观察终末温血低钾停搏液再灌注技术对心脏瓣膜置换术患者的心肌保护作用。方法40例择期首次体外循环（ECC）下行心脏瓣膜置换术的患者，随机分为试验组和对照组，每组各20例。升主动脉开放前，对照组在主动脉根部灌注ECC温血5min；试验组先在主动脉根部灌注含磷酸肌酸（10mmol／L）的温血低钾停搏液7ml／kg，待3min后再继续灌注ECC温血5min。结果试验组的心脏自动复跳率90％，对照组60％，两组比较差异有统计学意义（P〈0．05）；复苏后多巴胺的最大剂量试验组、对照组分别为（3．7±1．0）、（6,5±1．2）[μg／（kg·min）]，差异有统计学意义（P〈0.05）；升主动脉开放后4、10h的肌酸激酶同工酶（CK-MB）水平，试验组均明显低于对照组（P〈0.05）。结论终末温血低钾停搏液再灌注技术对心脏瓣膜置换术患者具有较好的心肌保护作用。

Objective To evaluate the clinical effect of terminal warm blood hypokalemia cardioplegia reperfusion for myocardial protection in the patients undergoing valve replacement. Methods Forty patients undergoing elective valve replacement were randomly divided into two groups： experimental group （n = 20） and control group （n = 20）. Before aortic unclamping, the experimental group was reperfused with warm blood hypokalemia cardioplegia plus creatine phosphate （10 mmol/L） 7 ml/kg,then reperfused with warm blood 3 minutes later for 5 minutes, whereas the control group reperfused with warm blood only. Results In the experimental group, the ratio of myocardial auto-resuscitation was 90%,it was higher than that in the control group 60%（ P 〈 0.05 ）, the dose of positive inotropic medicine were（ 3.7 ± 1.0）, （6.5± 1.2 ） （μg/kg·min） in the experimental and control group （P 〈0.05）,the levels of serum creatine kinase MB （CK-MB） at 4,10 hours after aortic unclamping were lower in the experimental group （P 〈 0.05）. Conclusion The terminal warm blood hypokalemia cardioplegia reperfusion is of benefit to the myocardial protection in patients undergoing valve replacement.