心脏不停跳心内直视手术中心肌损伤程度的评估

Evaluation of Myocardial Injury in Open Heart Surgery on Beating Heart

目的 通过与常规心脏停搏下心内直视手术中心肌损伤程度的对比研究，客观评价心脏不停跳心内直视手术中心肌损伤的情况。 方法 ２２ 例单纯房间隔缺损或室间隔缺损患者随机分为两组。对照组：在常规方法下行心内直视手术，术中控制心肌缺血时间在３５ 分钟以内；实验组：在浅低温体外循环，阻断上、下腔静脉，心脏不停跳下完成心内直视手术。测定心肌同工酶释放活性，三磷酸腺苷含量以及观察心肌超微结构等。 结果 实验组心肌同工酶释放量低于对照组（ Ｐ＜ ０．０５ 或 Ｐ＜ ０．０１），且术后恢复较快。心肌三磷酸腺苷含量和心肌超微结构基本正常，并优于对照组。 结论 心脏不停跳心内直视手术中心肌损伤极轻，符合微创外科的要求。

Objective To study objective evaluation of the extent of the myocardial injury was carried out.Methods Twenty two patients with atrial septal defect and ventricular septal defect were randomly divided into two groups. The patients in control group were operated under the middle hypothermal extracorporeal circulation and aortic cross clamping with cardiac arrest while in experimental group were operated under light hypothermal extracor poreal circulation on beating heart. The myocardial isoenzyme releasing activity, adenosine triphosphate in content in myocardium were assayed and ultrastructures were observed. Results The isoenzyme releasing activity of myocardium in experimental group was much lower than that in control group( P <0.05 or P <0.01),but higher than the baselevel( P<0.05) . The adenosine triphosphate content and myocardial ultrastructure were almost normal in experimental group, and higher or better than those in control group. Conclusion Open heart surgery on beating heart could reduce the myocardial injury at the great extent, which may be considered as minimally invasive heart surgery.