大剂量抑肽酶对体外循环心内直视手术病人心肌的保护作用

Myocardial Protective Effects of Large Dose of Aprotinin during Open Heart Surgery under Cardiopulmonary Bypass

目的 :观察体外循环 (CPB)心内直视手术中使用大剂量抑肽酶 (aprotinin)对心肌保护的影响。方法 :12 0例心脏瓣膜置换手术病人 ,随机分成两组 :A组 (抑肽酶组 ,n =6 0 ) ,B组 (对照组 ,n =6 0 ) ,AB两组均在主动脉阻断后行冷晶体停跳 ,至开放前作末次温血灌注。A组于麻醉诱导后心肺转流前静滴抑肽酶 1× 10 6KIU ,体外循环预充液中加入 2× 10 6KIU ,另 1× 10 6KIU在转机后静滴至术毕。B组于诱导后在外周静脉及预充液中以相等容量的乳酸林格氏液代替。记录两组转机时间、主动脉阻断时间、开放至复跳时间、自动复跳或电击复跳、复跳后低血压及术后 2 4小时低血压情况。结果 :两组转机时间、主动脉阻断时间、开放至复跳时间无显著差异 (P >0 0 5 ) ,A组的自动复跳率、复跳后低血压发生率及术后 2 4小时低血压发生率均优于B组 (P <0 0 5 )。结论 :CPB心内直视手术中使用大剂量抑肽酶能加强心肌保护的效果 。

Objective:To investigate the myocardial protective effects of large dose of aprotinin during open heart surgery under cardio pulmonary bypass(CPB).Methods:120 patients undergoing cardiac valvular replacement operation were randomized into aprotinin group(group A, n= 60) and control group(group B, n= 60).In both groups,cold cardioplegia solution was infused right after aortic cross clamping and warm blood was infused before aortic clamping was opened.In group A,1×10 6 KIU of aprotinin was dripped intravenously before CPB,2×10 6KIU of aprotinin was added into the prime solution and 1×10 6KIU was dripped intravenously from the beginning of CPB to the end of operation.In group B,the same volume of Ringer′s solution was given instead of aprotinin.Results:There were no significant differences in duration of bypass,aortic cross clamping time and the time from aortic opening to resumption of heart beating between group A and group B( P> 0 05).Incidence of spontaneous resuscitation was higher in group A than that in group B.( P< 0 05).Incidence of hypotension after resumption of heart beating and in the following 24h was higher in group B than that in group A.( P< 0 05).Conclusion:Large dose of aprotinin is helpful to myocardial preservation.