体外循环中应用常温含血停搏液诱导停搏的心肌保护作用

Myocardial protection of warm blood cardioplegic induction during cadiopulmonary bypass

目的 评价在体外循环中常温含血停搏液诱导心肌停搏的心肌保护作用。方法 将2 8例成年瓣膜置换手术患者随机分为试验组 (T组 ,n =14)和对照组 (C组 ,n =14) ,T组以常温含血停搏液 (35℃～ 37℃ )诱导心肌停搏直至心电图 (ECG)为直线 ,再改用冷血停搏液 ;C组则直接以单纯冷血停搏液 (6℃～ 8℃ )诱导心肌停搏。分别于麻醉诱导后、停机、停机后 6小时、停机后 2 4小时采集动脉血、以ELISA法测定血浆中心肌肌钙蛋白T(cTnT)浓度、分别于冠脉循环阻断前及开放 10分钟取右心房肌组织 ,在H - 70 0 0透射电镜下观察心肌形态学。结果 (1)临床效果 :T组自动复跳率(93% )明显高于C组 (5 0 % ) (P <0 0 5 ) ;需安装临时起搏器者 ,T组 1例 (7% ) ,C组 3例 (2 1% ) ,无显著性差异 (P >0 0 5 ) ;T组在围术期需没有使用多巴胺者 (0 % ) ,明显少于对照组的 5例 (36 % ) (P <0 0 5 ) ;术后拔除气管插管的时间及ICU停留时间T组亦明显短于C组 (P <0 0 5 )。 (2 )心肌生化 :在停机时和停机 6小时 ,T组血浆cTnT浓度明显低于C组 (P <0 0 5 )。 (3)心肌形态学 :T组明显优于C组。结论 在体外循环中应用常温含血停搏液诱导停搏 ,较单纯的冷血停搏液具有更明显的心肌保护作用。

Objective To evaluate the myocardial protection of warm blood cardioplegic induction during cardiopulmonary bypass(CPB) Methods Twenty-eight adult patients undergoing valve replacement ,were devided randomly into two groups : in group test (group T,n=14) the warm (35℃-37℃) blood cardioplegia was infused to induce ECG straight line ,followed by the administration of the cold (6℃-8℃) blood cardioplegia , whereas in group control (group C ,n=14) the cold blood cardioplegia was applied simply The aterial blood samples were taken to measure the plasma concentration of cardiac troponin T (cTnT) with ELISA methods immediately after anesthesia induction,and immediately ,6 h, 24 h after the weaning from CPB The myocardial samples of right atrium were taken to observe the morphology with the transmission electron microscpe Results The rate of restoring spontaneous heart-beat in group T (93%) was significantly higher than that in group C (50%) One case in gruop T (7%) and three cases in group C (21%) required the interim pacemakers No case in group T (0%) and five cases (36%) in group C required the administration of dopamine perioperatively The durations of post-operative mechanical ventilative support and ICU-staying of group T were obviously shorter than those of group C The plasma level of cTnT in group T was obviously lower than that in group C immediately and 6 h after CPB Myocardial morphology in group T got much better outcome than that in group C did Conclusions Warm blood cardioplegic induction during CPB can provide better myocardial protection than cold blood cardioplegic induction