浅低温体外循环不停跳心内直视术的心肌保护

The Cardiopulmonary Bypass Shallow Hypothermia Orthoptic Cardiac Surgical in Beating Heart for the Myocardial Protection

目的:探讨浅低温体外循环不停跳心内直视术的心肌保护。方法:30例心内直视术患者被随机平均分为心脏停跳和不停跳两组。停跳组降温至食管温度25±1.35℃,并从升主动脉根部灌注冷高钾停跳液,灌注量15ml.kg-1,同时在心脏表面及心腔内置0.9%氯化钠溶液浸泡,使心脏停跳,阻断升主动脉。不停跳组降温至食管温度33±0.8℃,只阻断上、下腔静脉,不阻断主动脉,控制心率在40～70次.min-1。结果:两组病例术中血流动力学均较稳定,无明显差异。但两组CK-MB、CK、LDH、α-HBDH均较术前增高,尤以停跳组明显,两组比较有显著差异。结论:心内直视术麻醉采用浅低温心脏不停跳体外循环技术对心肌具有较好的保护作用,但仍然存在需要进一步解决的问题。

Objective：To investigate the myocardial protection of cardiopulmonary bypass shallow hypothermia orthoptic cardiac surgical in beating heart. Methods： Thirty patients of orthoptic cardiac surgery were divided into two groups, no-keating heart group and heart-beating group. The omfisopm of heart temperature was cooled to the esophagus temperature at aboct 25 ± 1.35 ℃, combine ind the cardiopleyia solutions of cold and high potassium from rise the aorta root, about 15 ml·kg^-1 , at the same time, ice saline was put in heart surface and heart caves, with the result that the heart stoped to beat, the aortic crossclamped. The set of beating heart cooled to the esophagus temperature at about 33 ± 0.8℃, the top and bottom vein were clamped and aortic was not clamped, controled the heart rate at 40 to 70 times/min. Results： Vital signs in two groups were all stable. But the levels of CK- MB, CK, LDH, α - HBDHs were all increased than the surgical operation, particularly in No- beating heart group. Conclusion： The cardiopulmonary bypass shallow hypothermia orthoptic cardiac surgical in beating heart have a good protection function to the myocardial, but still exsits problem that demand further resolve.