先天性心脏病矫治手术中心脏复跳前氧和血再灌注时不同压力对心脏手术中心肌保护的影响

Relationship between the Pressure of the Reperfusion and the Myocardial Reperfusion Injury during Correction of Cardiac Defects in Children

目的评估在心内直视手术中心脏复跳前再灌注时不同压力对心肌保护的影响。方法选取40例先天性心脏病患者,分为高压组和低压组,每组20例。术前两组间性别、年龄、体重、身高、畸形种类、心胸比率及射血分数(EF)无明显区别。两组在升主动脉开放前经主动脉根部灌注36℃氧合血,高压组(A组)灌注压力为12KPa,低压组(B组)灌注压为6KPa,灌注量总量均为20ml/kg。分别于麻醉诱导及术后24h抽取静脉血,检测肌酸磷酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnI)的变化,并记录停机时、手术结束后2h和手术结束后24h各时点血流动力学变化。结果低压组于术后24h时点CK-MB及cTnI浓度均显著低于对照组(P<0.05),复跳后血流动力学参数显著优于对照组(P<0.05)。结论心脏复跳用较低压力灌注,有助于缺血再灌注后心功能的恢复及改善。

Objective：To investigate the relationship between the pressure of the reperfusion and the myocardial ischaemic and reperfusion injury （MIRI）during correction of conginital cardiac defects in children. Methods：20 children undergoing correction of cardiac defects were divided into two groups randomly.Before The aorta blocking clamp released,warm oxygenated blood was reperfused into the heart.In group A,the reperfusion pressure was 12kPa and 6kPa was used in group B. There were no significant differences between the two groups in age, sex, ratio, diagnosis, C/Tratio, or leftventricular function. Blood samples were collected before aortac annulation and other times. Analysis of creatine kinase MB and cardiac-specific troponin I was made for detection of myocardial damage. Post ischemic ultrastructure in heart was also observed in two groups. Results： The CK-MB and cTnI concentration were much lower in group B than that in group A 24 hours after operation （P〈0.05）. Conclusion：The lower pressure can improve significantly the myocardial protective effect of the St. Thomas No 1 solution in correction of cardial defects in children.