三种心脏停搏液对心肌保护的对比研究

Comparison Study of Myocardial Protection with Three Kinds of Cardioplegia

目的 :评估 3种心脏停搏液的心肌保护作用。 方法 :3 0例风湿性单纯二尖瓣病变患者随机分为温血停搏液持续灌注组 (温血组 ,n=10 )、冷血停搏液间断灌注组(冷血组 ,n=10 )及冷晶体停搏液间断灌注组 (冷晶体液组 ,n=10 ) ,观察血浆心肌肌钙蛋白 T( c Tn T)、内皮素 - 1( ET- 1)、心钠素 ( ANP)和心肌超微结构改变。 结果 :1体外循环后冷晶体液组血浆 c Tn T较其它 2组明显增高 ;2血浆 ET- 1在主动脉开放后温血组下降速度最快 ,冷晶体液组含量最高 ;3血浆 ANP在主动脉阻断后 15分温血组上升 ,其它 2组在主动脉阻断后迅速下降 ;4复跳后心肌超微结构冷晶体液组损伤最重 ,温血组最轻。 结论 :血浆 c Tn T、ET- 1、ANP及心肌超微结构改变 ,反映了心肌缺血再灌注损伤 ;温血停搏液的心肌保护作用优于冷血停搏液和冷晶体停搏液。

Objective:To evaluate the effects of three kinds of cardioplegia on open heart surgery. Methods:Thirty patients with rheumatic mitral vavular disease underwent valve replacement and were randomized to receive warm blood cardioplegia (WBC group, n =10),cold blood cardioplegia (CBC group, n =10)and cold crystalloid cardioplegia(CC group, n =10) delivered antegrade.The plasma cardiac troponin T (cTnT),endothelin 1 (ET 1),atrial natriuretic peptid (ANP) and myocardial ultrastructure were measured. Results:①The cTnT concentration increased significantly greater ( p <0 05) in the CC group than in the other groups during postoperation.The cTnT concentration peaked at 12 hours in the WBC group and CBC group,at 48 hours in the CC group.②The ET 1 concentration declined the most rapidly in the WBC group and was lower than the other groups.③The ANP concentration increased at 15 minutes after aortic cross clamped in the WBC group.However,the ANP concentration declined immediately after aortic cross clamping and increase after aortic de clamped in the CBC group and CC group.④Ultrastructure of the right atrial myocardium showed severe damage in the CC group. Conclusion:Release of cTnT,ET 1 and ANP should be useful in determining myocardial damage.Warm blood cardioplegia appears to be superior to cold blood and cold crystalloid cardioplegia.