心脏停跳与不停跳手术心肌保护的临床对比研究

Comparative study of myocardial protection in cardiac arrest and beating heart surgery

目的评价心脏停跳与不停跳手术对先天性心脏病患者的心肌保护效果。方法房间隔缺损（ASD）、室间隔缺损（VSD）、肺动脉瓣狭窄（PS）患者共116例，随机分为实验组（不停跳组）和对照组（停跳组）。实验组在体外循环（CPB）心脏跳动状态下手术，对照组在CPB心脏停跳下手术，分别于术前及术后2、6、24、48h采集血标本，检测血清肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）、天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）含量；记录CPB时间、术后48h心律失常发生率、残余分流发生率、呼吸机支持时间、ICU滞留时间、术后住院天数。结果两组术后各时点血清CK—MB、cTnI、AST、LDH含量均显著高于术前（P〈0．01），但两组间各时点比较差异无统计学意义（P〉0．05）；实验组CPB时间较对照组短（P〈0．01），其他临床观察指标与对照组比较差异无统计学意义（P〉0．05）。结论体外循环心脏不停跳心内直视手术能缩短CPB时间，但手术效果与停跳手术比较差异无统计学意义。

Objective To evaluate the protective effects of cardiac arrest and beating heart on patients with congenital heart disease （CHD）. Methods One hundred and sixteen CHD patients were randomly divided into experimental group （beating heart group） and control group （cardioplegia group）. The experimental group received surgery on beating heart with cardiopulmonary bypass （ CPB）, cardiac arrest operation under CPB in the control group, respectively. Blood samples were taken and the serum levels of creatine kinase MB （ CK-MB）, troponin I （ cTnI）, aspartate aminotransferase （ AST）, lactate dehydrogenase （LDH） were detected before operation and 2, 6, 24, 48 hours after operation. The clini- cal parameters including CPB times, incidence of arrhythmia, residual shunt occurred rate, duration of mechanical ventilation, ICU stay time and postoperative hospital stay were detected respectively. Results Postoperatively, the CK-MB, cTnI, AST, LDH levels were significantly higher than those before （P 〈 0. 01 ）, but there were no significant differences between the two groups （P 〉 0.05 ） ; The CPB time of experimental group were shorter than that of control group（ P 〈0.01 ）. Other clinical parameters between the two groups showed no significant difference （ P 〉 0.05 ）. Conclusions The beating heart surgery can simply shorten the operating time, but the effect on myocardial protection has no difference as corn-pared with that of cardiac arrest surgery.