先天性心脏病心内直视手术中改良缺血后处理对心肌的保护作用

Protection of Cardiac Muscle with the Improved Ischemic Postprocessing during Open Heart Operation for Congenital heart Disease

目的：探讨先天性心脏病（CHD）体外循环（CPB）心内直视手术中改良缺血后处理对心肌的保护作用。方法：30例CHD患者按病种随机均分为两组。实验组在常规CPB主动脉阻断心内直视手术完成后，实施改良缺血后处理；对照组行常规CPB主动脉阻断心内直视手术。分别于术前（T1）、主动脉开放前（T2）、主动脉开放后30min（T3）、术后6h（T4）、术后24h（L）、术后72h（T6）、术后6d（T7）各时点采集静脉血，测定红细胞压积（HCT）、心肌肌钙蛋白Ⅰ（cTnI）、磷酸肌酸激酶（CK）、丙二醛（MDA）；观察并比较两组术后心脏自动复跳率、室性心律失常发生率、正性肌力药物使用率及呼吸机应用时间。结果：（1）对照组在T3～T6时点cTnI、CK含量及T3～T4时点MDA含量高于实验组（P〈0．05）；（2）实验组多巴胺等正性肌力药物使用率及呼吸机应用时间低于对照组（P〈0．05），心脏自动复跳率高于对照组（P〈0．05）。结论：改良缺血后处理能够很好地保护心肌，具有一定的临床可行性，值得推广应用。

Objective：To investigate the myocardial preservation with improved ischemic postprocessing during open heart surgery for congenital heart disease. Methods：Thirty patients with congenital heart disease were randomly divided into experimental group （ n = 15 ） and control group （ n = 15 ）. These patients routinely accepted the blockage of aorta during eardiopulmonary bypass （CPB）. When the operations had been carried out, the improved ischemic postprocessing was performed on the patients in the experimental group. Blood samples were taken from all the patients for detection of haematocrit （ HCT）, cardiac troponin （ CTn）, phosphocreatine kinase （CK） and malondialdehyde （MDA） at various time points, including before operation （T1） , just before aorta opening （T2 ）, 30 minutes after aorta opening （T3 ）, 24 h （T4 ） ,48 h （T5 ） ,72 h （T6 ） and 6 d after the operations（T7 ） , respectively. To observe and record the percentage of automatical heart beating after operation, incidence of ventricular arrhythmia, doses of inotropic agents,the applied duration of breathing machine, and so on. Results ：The levels of cTnI and CK at T3 and T6 （ P 〈 0.01 ） , MDA at T3 and T4 （ P 〈 0.05 ） in the control group were higher than those in the experimental group. The doses of inotropic agents and the applied duration of breathing machine in experimental group were lower and shorter than those in control group（ P 〈 0.05 and P 〈 0.01, respectively）. However, The percentage of automatical heart beating after operation was higher than that in control group（ P 〈 0.05 ）. Conclusions ：The improved ischemie postprocessing could provide protection for cardiac muscle, which is feasible and worth spreading its clinical application.