氧合血心脏停搏液保护心肌的研究

A Comparative Clinical Study of Warm Blood Cardioplegia Versus Cold Crystalloid Cardioplegia for Myocardial Protection

目的 :为了寻求临床上更为安全实用的心肌保护方法 ,对冷晶体心脏停搏液间断灌注和浅低温氧合血、常温氧合血心脏停搏液持续灌注两种方法保护心肌的作用进行了比较研究。方法 :应用冷晶体心脏停搏液间断灌注(CCC组 )、浅低温氧合血、常温氧合血心脏停搏液持续灌注心肌保护方法 ,观察了心脏瓣膜直视手术 48例患者术后主要并发症、起搏器的使用情况 ,测定了主要心肌酶 ,肌酸激酶 (CK)、肌酸激酶同功酶 (CK -MB)、乳酸脱氢酶同功酶 (LDH1/LDH2 )的释放 ,丙二醛 (MDA)、超氧化物歧化酶 (SOD)、三磷酸腺苷 (ATP)的含量以及能量储备 (EC)值 ,心肌超微结构的变化。结果 :氧合血心脏停搏液持续灌注方法术后低心排血量综合征、室性心律失常发生例数和起搏器使用率较低 ;CK、CK -MB释放减少 ;氧自由基产生和ESOD消耗减少 ;能量保存较多 ;心肌超微结构的变化较轻。结论 :氧合血心脏停搏液持续灌注比冷晶体心脏停搏液间断灌注在心肌保护方面具有明显的优越性 ,是一种较好的心肌保护方法。

WT5”BZ]Objective:Myocardial protection is one of the most important part in open heart surgery which directly influences the efficacy iof surgery.The present study was designed to make an effort to detect the method of myocardial protection.Methods:Forty-eight patients were randomly divided into cold crystalloid cardioplegia group (CCC)、cool blood cardioplegia(CBC)and warm blood cardioplegia (WBC) group.The operative complications,use of pacemaker,release of CK,CK-MB,LDH 1/LDH 2,contents of MDA,SOD,ESOD,ATP and EC and ultrastructural changes of myocardium were observed for comparative studies.Results:The results showed that the postoperative complications could be reduced significantly by the method of continuous oxygenated blood cardioplegia.The method could decrease the release of CK、CK-MB、MDA,and preserve the contents of ESOD and EC.It helped to preserve well the myocardial ultrastructures.Conclusion:The continuous warm oxygenated blood cardioplegia is a good method for myocardial protection,and is superior to intermittent cold crystalloid cardioplegia. [WT5”HZ]