冷血停搏液对5岁以下儿童先天性心脏病心肌保护效果的观察

A Clinical Comparison between Cold Crystalloid and Blood-Based St Thomas' Hospital Cardioplegic Solution in Congenital Heart Disease

目的 :本研究通过临床应用探索适用于 5岁以下儿童心脏直视手术的心肌保护方法。 方法 :5 0例行择期法乐四联症根治术患儿随机分为 2组 :对照组用冷晶体停搏液 ,实验组用冷血停搏液。阻断前 ,开放冠状动脉循环后 1,3,10 min分别由冠状静脉窦和动脉同时取血进行血气分析 ,并测定乳酸、丙二醛含量。术前、开放升主动脉后 2 ,4,8,2 4,48h测定心肌酶谱。心脏停跳前 ,开放升主动脉后 5 min取右心室心肌观察超微结构改变 ,同时观察临床恢复情况。 结果 :实验组心电诱导停搏时间较长 ,量大 ,术后多巴酚丁胺及异丙肾上腺素平均最大剂量较高 ,使用时间较长 ,但心肌氧、乳酸摄取率恢复优于对照组 (P<0 .0 5 )。 结论 :冷血停搏液对紫绀型先天性心脏病患儿术中心肌保护效果较冷晶体停搏液无显著优越性。

Objective:This clinical study compared the protective effects of cold crystalloid with cold blood based St.Thomas' Hospital cardioplegic solution No.1 in children with tetralogy of Fallot. Methods:A consecutive series of 50 children who underwent selective operation were randomly devided into crystalloid and blood based cardioplegigroups.Blood gas,lactate,MDA were determined simultaneously in arterial and coronary venous sinus blood sample before sross dampig at 1,3,10 minutes after unclamping.Serum enzymes'concentration was measured before clamping,and at 2,4,8,24,48 hours after unclamping.Biopsies samples of right ventricular myocardium for electron microscopy were obtained before cross clamping and 5 minutes after aorta opening unclamping. Results:In the blood cardioplegia group,the time of electric arrest induction was much longer,the ratio of resuming sinus rhythm was lower,and more inotropic support was meeded after operation.The cumulative release of the serum (iso) enzymes and the myocardial ultrastructure were similar between two groups.The lactate and oxygen extraction ( p <0 05) change were milder in the blood cardioplegia group. Conclusion:The difference in myocardial preservative effects between cold crystalloid or cold blood based St.Thomas' Hospital cardioplegic solution No.1 in infants with tetralogy of Fallot is minial.