不同浓度的低钙停搏液对未成熟心肌保护的临床研究

The Clinical Study on the Protection of the Neonatal Myocardium with Different Concentrations of Low Calcium Cardioplegic Solutions

目的：探讨不同浓度低钙冷晶体停搏液对未成熟心肌的保护作用,通过对心肌指标的检测,得出适宜的钙离子浓度,以对未成熟心肌进行充分保护。方法：采取随机、对照的方法选取先心患儿40例,入选标准：6个月~3岁,体重小于5 kg或体重虽大于5 kg,但严重发育不良,体重小于实际年龄应有体重的70%,男女不限,40例患者随机分为4组,用随机阳性对照单盲试验方案。实验组Ⅰ冷晶体停搏液中Ca2＋浓度为0 mmol/L,Ⅱ中Ca2＋浓度为0.5 mmol/L,Ⅲ中为1.0 mmol/L,对照组（Ⅵ）采用ThomasⅡ型冷晶体停搏液Ca2＋浓度为1.2 mmol/L,每组10例,使各组组间临床资料比较无显著差异,具有可比性,检测指标LDH,CK,CK-MB,cTnI以确定心肌保护的效果。结果：各组术前指标无明显差异,除Ⅱ组自动复跳率较其他组高外,术中各指标亦无明显差异,术后各组不同时间内的心肌指标（LDH、CK、CK-MB、cTnI）其差异也不相同。结论：通过对心肌酶（LDH、CK、CK-MB、cTnI）各项指标检测,停搏液钙离子浓度为0.5 mmol/L时,与ThomasⅡ型停搏液及其它各组对比,对未成熟心肌保护效果最佳（P〈0.05）。

Objective：The aim of this study was to obtain an appropriate concentration of calcium ions in crystalloid cardioplegic solution to protect the neonatal myocardium thoroughly and assess the protection of crystalloid cardioplegic solution with different concentrations of calcium through detecting the cardiac index.Methods： Selecting the 40 cases of congenital heart patients with a randomized and compared method whose age were from June month to 3 years and weight were less than 5 kg or although the weight were beyond 5 kg,but it were less than 70% of the normal weight.40 patients were randomly divided into 4 groups,with a single blind and randomizing control trial program.The concentration of calcium ions in crystalloid cardioplegic solution is 0mmol / L in the experimental groupⅠ,the Ca2 ＋ concentration is 0.5 mmol / L in the group Ⅱ and group Ⅲ that the concentration is 1.0 mmol / L.The control group（Ⅵ） which is the type of Thomas Ⅱ that is also cold crystalloid cardioplegic solution whose Ca2 ＋ concentration is 1.2 mmol / L.There were 10 cases in each group.There were no obviously difference between the clinical data in each group.Using the index LDH,CK,CK-MB and cTnI to assess whether the myocardial protection were efficient.Results： There were no significant preoperative differences,except the rate that myocardial rhythm recovered by itself in group Ⅱ is higher than other groups,the index during the operation were also no significant different in each group.The cardiac index（LDH,CK,CKMB,cTnI） were different from each other at the different times after operation.Conclusion：When the calcium concentration was 0.5 mmol / L in the cardioplegic solution,the myocardial protection is the better than the Thomas Ⅱ solution and the other groups through analyzing the myocardial enzymes（LDH,CK,CK-MB,cTnI）（P0.05）.