冷血心脏停搏液及低温心室颤动法在冠状动脉旁路移植术中心肌保护的效果

Clinical Outcomes of Cold Blood Cardioplegia and Intermittent Cross Clamping as Myocardial Preservation in Coronary Artery Bypass Grafting

目的 评价冷血心脏停搏液和低温心室颤动法在冠状动脉旁路移植术 (CABG)中心肌保护的临床效果。方法 根据不同的心肌保护方法 ,将 2 0 13例患者分为两组 ,冷血心脏停搏液组 :5 96例采用冷血心脏停搏液保护心肌 ;低温心室颤动组 :1417例采用低温心室颤动法保护心肌。两组均为单纯、择期 CABG手术 ,观察心肺转流术(CPB)时间 ,升主动脉阻断时间 ,ICU监护期 ,住院死亡率 ,主动脉内气囊泵 (IABP)使用率 ,中枢神经系统并发症及肾功能衰竭发生率。 结果 术中冷血心脏停搏液组与低温心室颤动组旁路移植血管支数无差异 ,冷血心脏停搏液组CPB时间、升主动脉阻断时间明显长于低温心室颤动组 (P<0 .0 1)。术后 ICU监护期、中枢神经系统和肾功能衰竭并发症及术后住院死亡率两组间无差异。 结论 单纯、择期 CABG手术患者 ,低温心室颤动法仍是一种安全、有效的心肌保护方法 ,其临床效果可能优于冷血心脏停搏液法。

Objective\ In order to assess and evaluate the clinical results of cold blood cardioplegia and intermittent cross clamping as myocardial preservation in coronary artery bypass grafting(CABG).\ Methods\ According to the management methods, 2 013 cases for elective, isolated CABG were divided into two groups at St.George's Hospital, London.Cold blood cardioplegia group: 596 patients treated with cold blood cardioplegia, and hypothermic ventricular fibrillation group: 1 417 patients treated with intermittent cross clamping ischemia and hypothermic ventricular fibrillation. The variables used for assessment were cardiopulmonary bypass time, cumulative cross clamping time, hospital mortality, intensive care unit stay, usage of intro aortic balloon pump and stroke and renal failure incidence.\ Results\ There was no significant differences for grafts between cold blood cardioplegia group and hypothermic ventricular fibrillation group. Cardiopulmonary bypass time and cross clamping time was found to be longer in cold blood cardioplegia group than that in hypothermic ventricular fibrillation group (P<0 01). There were no significant differences in in hospital mortality, intensive care unit stay and other complications between the two groups.\ Conclusion\ Intermittent cross clamping with hypothermic ventricular fibrillation is still as effective, safe a strategy to protect the myocardium as cold blood cardioplegia for elective,isolated coronary artery operations. The method may be better than cold blood cardioplegia because of shorter cardiopulmonary bypass time and cross clamping time.