自体冷血停搏液在心脏瓣膜置换术中对心肌保护作用的研究

Myocardial protection of Autologous Cold Blood Cardioplegia in Heart Valve Replacement Surgery

目的探讨自体冷血停搏液在心脏瓣膜置换术中对心肌的保护作用。方法将心脏瓣膜病患者40例,随机分为自体冷血停搏液组(A组)和4∶1冷含血停搏液组(B组),每组20例。分别于术前、术后6 h、24 h及48 h经桡动脉取血3 ml,采用酶联免疫吸附实验(ELISA)检测心肌肌钙蛋白I(cTnI)、磷酸肌酸激酶同功酶(CK-MB)及心肌型脂肪酸结合蛋白(H-FABP)含量。结果两组患者术后cTnI、CK-MB和H-FABP明显升高,均于术后6 h达高峰,与术前水平比较,显著升高(P<0.01),随后逐渐下降,术后48 h基本接近正常水平(P>0.05)。术后6 h,B组患者三者水平明显高于A组(P<0.05),其余各时点比较,差别无统计学意义(P>0.05)。A组患者心脏自动复跳率明显高于B组(P<0.05),而多巴胺应用时间及呼吸机辅助时间明显少于B组(P<0.05)。室性心率失常发生率、死亡率及低心排发生率两组间差别无统计学意义(P>0.05)。结论自体冷血停搏液能显著降低血浆cTnI、CK-MB及H-FABP水平,能明显提高心脏自动复跳率、减少多巴胺应用及呼吸机辅助时间。自体冷血停搏液在心脏瓣膜置换术中对心肌保护效果优于4∶1冷含血停搏液,对心脏停搏下心内直视换瓣术心肌保护有重要意义。

Objective To investigate the myocardial protection of autologous cold blood cardioplegia in heart valve replace- ment surgery. Methods Forty valvular heart disease patients were randomly divided into autologous cold blood cardioplegia group（ group A,20 cases） and the 4： 1 cold blood cardioplegia group（ group B,20 cases）. 3 ml blood were obtained before operation and 6 h,24 h,48 h after the operation via the radial artery. The blood level of cTnI, CK-MB and H-FABP were analyzed by using ELISA. Results The level of cTnI, CK-MB and H-FABP increased significantly and achieved peak at 6 h after the operation（P 〈 0.01 ）,then decreased gradually, descended to the normal level after 48 h. There was significant difference between group A and group B （ P 〈 0.05 ） in the blood lead of cTnI, CK-MB and H-FABP 6 h after the operation. Auto-recovery heart rate of group A was significantly higher than group B （ P 〈 0.05 ）, but dopamine application time and ventilation time was less than group B（ P 〈 0.05 ）. Conclusion The autologous cold blood cardioplegia can significantly decrease the levels of cTnI, cCK-MB and H-FABP,improve the rate of cardiac auto-resuscitation, reduce dopamine application time and ventilation time. The autologous cold blood cardioplegia was superior to 4： 1 cold blood cardioplegia in the myocardial protective of heart valve replacement