不同心肌保护方式在冠状动脉搭桥术中的应用

Three different protocols of myocardial protection in coronary artery bypass grafting

目的:评价3种不同心肌保护方法在冠状动脉(冠脉)搭桥术中的应用。方法:分析63例选择性冠脉搭桥术病人,分为冷晶体停跳液组(CC组)、含血停跳液组(BC组)和低温室颤组(HF组),对比其手术进程、心肌酶指标、心电图变化和临床疗效。结果:CC组、BC组和HF组体外循环时间和停跳时间差异无显著性。CK、GOT和LDH术后1d均高于术前,LDH术后1周仍维持较高水平;3种心肌酶的组间差异无统计学意义。心电图表现、术后机械通气时间和监护时间均无差异。CC组死亡1例,围术期心肌梗死(心梗)1例,心绞痛复发1例;BC组死亡2例,术后房扑、房颤和完全性右束支阻滞各1例;HF组死亡2例,围术期心梗1例,心绞痛1例。结论:3种心肌保护方式在冠状动脉搭桥术中都是行之有效的。

Objective: To assess the outcomes and use of three different protocols of myocardial protection in coronary artery bypass grafting(CABG). Methods: According to surgeons' preferences, 63 selective CABG patients were divided into Group CC(crystalloid cardioplegia), Group BC(blood cardioplegia) and Group HF(hypothermic ventricular fibrillation). The process of operations, enzymes, EKG and clinical outcomes were analysed. Results: The durations of cardiopulmonary bypass and arrest were similar among three groups. The levels of CK, GOT and LDH in serum of all the three groups were higher on the first postoperative morning than on preoperative days, and only LDH maintained high level 1 week after operation. There were no differences among three groups in all the time. The EKG changes, hours of ventilation and ICU stay were also similar. 5 patients died(1 in Group CC, 2 in Group BC and 2 in Group HF, respectively) , 2 patients developed perioperative infarction(Group CC and Group HF) and 2 patients with diabetes mellitus kept mild angina. There was 1 atrial flutter, 1 atrial fibrillation and 1 RBBB in Group BC. Conclusion: Three protocols of myocardial protection were all effective in CABG.