再次停搏温血灌注在体外循环手术心脏复苏困难治疗中的应用

Application effect of re-block the aorta and warm blood reperfusion in difficult cardiac resuscitation patients

目的观察含磷酸肌酸的氧合温血低钾停搏液诱停加体外循环(CPB)温血持续灌注治疗心脏复苏困难的疗效。方法 30例CPB下心脏复苏困难的心脏瓣膜手术患者,随机分为观察组和对照组,各15例。观察组再次阻断升主动脉,灌注含磷酸肌酸(10 mmol/L)的氧合温血低钾停搏液7 ml/kg使心脏再次停波,持续灌注温血,然后开放升主动脉。对照组采用CPB辅助加电击除颤。结果两组患者均复苏成功。两组主动脉阻断时间无显著差异,CPB时间和辅助循环时间实验组明显低于对照组(P<0.05),实验组复跳后多巴胺最大剂量和术毕CK-MB水平均明显低于对照组(P<0.05)。结论 含磷酸肌酸的氧合温血低钾停搏液诱停加CPB温血持续灌注治疗心脏复苏困难疗效满意。

Objective To evaluate the application effect of re-block the aorta and warm blood reperfusion in difficult cardiac resuscitation patients.Method 30 valvular patients with difficulty of cardiac resuscitation in open heart surgery with cardiopulmonary bypass（CPB） were randomly divided into experimental group（n=15） and control group（n=15）.In the experimental group,aorta was cross clamped again,the heart was reperfused with warm blood hypokalemia cardioplegia plus creatine phosphate（10 mmol/L） 7 ml/kg,then reperfused with warm blood.After the patients regained normal heart beat,the aorta was unclamped.Whereas the contral group cases were defibrillated.Result All cases were departed with CPB smoothly.There was no significant difference between the two groups in aortic cross-clamping time.The CPB time and CPB assistant time of the experimental group were shorter than that of control group（P〈0.05）.The dose of dopamine and the level of serum CK-MB after cardiac resuscitation were lower in the experimental group（P〈0.05）.Conclusion Re-block the aorta and warm blood reperfusion is effective for the cases with difficulty in heart resuscitation during open heart surgery.