体外转流全身高热对晚期肿瘤患者心脏功能的影响

Effects of Extracorporeal Whole Body Hyperthermia on Cardiac Function in Advanced Malignant Tumors

【目的】探索晚期肿瘤患者体外转流全身高热治疗(EWBH)过程中心肌是否存在损害。【方法】择期热疗手术患者32例。建立股静脉-股静脉血液转流,使机体温度升高至42℃维持120 min,然后将体外循环血冷却使机体体温降至38℃后停机。监测桡动脉平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、心电图ST段。并分别在转流加温前(A点)、加温到42℃(B点)、维持42℃60 min(C点)、维持42℃120 min(D点)、复温至38℃(E点)、停机后24 h(F点)等6点取上腔静脉血样,测定肌红蛋白与肌钙蛋白含量。【结果】与升温前比较,肌红蛋白(Myo)从D点开始升高,一直到术后24 h,差异有统计学意义(P<0.05)。肌钙蛋白(cTn-I)从C点起开始出现微量cTnI,D点起升高至F点,差异有统计学意义(P<0.05)。心电图ST段在42℃60 min后降低,到D点时最低(P<0.05)。随后逐渐恢复至术前水平。【结论】体外转流全身高热心肌发生可逆性损害,其原因有待进一步探讨。

[Objective] To confirm whether the humans myocardium were damaged in extraeorporeal whole body hyperthermia under general anesthesia. [Method] Thirty-two elective malignancy patients, extracorporeal whole body hyperthermia was performed by femoral vein-femoral vein extracorporeal using the machine made by The First Circle company. To warm-up the blood to keep the body temperature at 42 degrees for 120 min. Catheters were placed in left radial artery and right subclavian vein and right jugular bulb for sampling of blood. The samples were collected simultaneously in the time of before warm-up （A spot）, warm- up to 42 degrees （B spot）, 42 degrees 60 min （C spot）, 42 degrees 120 rain （D spot）, reduce the temperature to 38 degrees （E spot）, 24 hours after extracorporeal （F spot）. To monitor mean arterial pressure （MAP）, central venous pressure （CVP）, and hemoglobin heart rate （HR）. ST segment in cardioelectrogram were measured. Myo and CTn-I were measured with MEIA technique by Abbott AXSYM system. [Result] Myo and CTn-I increased significantly from C spot and D spot last to F spot compared to A spot （P 〈 0.05）. ST segment decreased significantly in hyperthermia compared to A spot （P 〈 0.05）, then recovered to baseline. [ Conclusion] Reversibility myocardium damage occurrence in EWBH, the reason need to be explored further.