血晶心停跳液不同流量连续灌注对心肌的保护作用

Study of enzyme function on blood crystalloid cardioplegia at different flow continuous perfusion

目的探讨1：1血晶心停跳液不同流量连续灌注对心肌的保护作用。方法选择80例择期行心脏手术患者，按照机械抽样法随机分为两组，分别用1：1血晶心停跳液微流量[0．5ml／（kg·min）]连续灌注（A组），高流量[2．0ml]（kg·min）]连续灌注（B组），每组各40例，分别记录术前，术后6、t2、24、48、72h肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）、乳酸脱氢酶（LDH）、乳酸脱氢酶同工酶（LDH。）的变化，进行组内和组间对比研究。结果A组停跳液总量为（41．72±7．98）ml／kg，B组为（142．09±9．65）ml／kg，A组明显低于B组（P〈0．05）。术后72h内，两组CK、CK—MB、LDH、LDH，均有不同程度升高，其峰值多在术后12、24h，与术前比较差异均有统计学意义（P〈0．05），两组心肌酶含量大部分在72h降至正常。组间比较差异无统计学意义（P〉0．05），两组术后需循环和呼吸辅助时间短，心功能恢复迅速、稳定。结论微流量1：1血晶心停跳液连续灌注亦能保持心肌能量储备，术后心功能恢复迅速。

Objective To investigate the effects of different flow volume of continuous 1 ： 1 blood crystalloid cardioplegia on open heart surgery. Methods Retrospective randomized study was performed on 80 patients undergoing valve replacement and congenital heart disease with 1 ： 1 blood crystalloid cardioplegla by minimum-flow continuous perfusion [0.5 ml/ （kg·min）,group A,40 cases], high-flow continuous perfusion [（2.0 ml/ （kg·min）,group B,40 cases）. The changes of creatine kinase （CK）, isoenzyme of creatine kinase （CK-MB）, lactate dehydrogenase （LDH）, lactic dehydrogenase isoenzyme （LDHj） were detected before operation and at 6, 12, 24, 48, 72 h after operation. Results The cardioplegia liquid was （41.72 ± 7.98 ） ml/kg in group A, （ 142.09 ± 9.65 ） ml/kg in group B ,there was significant difference between two groups （P 〈 0.05 ）. During the first 72 h postoperative the value of CK,CK-MB,LDH and LDHt in two groups were increased to different degree, serum enzymes level increased significantly between 12,24 h after operation （P 〈 0.05 ） and return to normal at 72 h after operation in two groups. But between two groups there was no significant difference （P 〉 0.05）. Conclusion Minimum-flow continuous perfusion of 1 ： 1 blood crystalloid eardioplegia appears to be superior in safety, decrease of myocardial enzymes integrity.