不同温度含氧血停跳液的临床应用价值

Value of Clinic Application of Oxygeneting Blood Cardioplegia with Different Temperatures

目的 评价三组不同温度含氧血停跳液的临床应用价值。方法 选择 30例病人 ,分为三组。手术中分别实施温血停跳组 (n=10 ) (34～ 36℃ ) ;中低温停跳组 (n=10 ) (2 4～ 2 8℃ ) ;低温停跳组 (n=10 ) (15～ 2 0℃ ) ,分别在不同的时点测量血清磷酸肌酸激酶值。分析动静脉血气值 ,推算心肌耗氧摄取率和血流动力学改变 ,并行心肌活检病理学检查 ,行统计学处理。结果 血流动力学改变 ,温血组复苏后心率偏慢 ,与中低温组和低温组比较有统计学意义(P<0 .0 5 ) ,低温组复苏后心率偏快 ,与温血组和中低温组比较 P<0 .0 5 ,静脉压偏高 ,与前两组比较 P<0 .0 5。血清CK水平 :温血组与中低温组比较无显著差异 (P>0 .0 5 )。低温组血清 CK水平与前两组比较有显著差异 (P<0 .0 5 ) ;甚至在 2 4小时后仍高 ,持续时间长。提示低温对心肌的损害是明显的。病例活组织检查也证实低温组的心肌线粒体细胞器损害以及空泡样变 ,比温血组和中低温组严重。结论 不同温度含氧血停跳液都有临床使用价值 ,但中低温含氧血停跳液更有临床应用价值。

Objective Thirty patients undergone cardiac valve operation were selected for comparing the value of blood cardioplegia with different temperatures used in cardiopulmonary bypass in open heart surgery.Methods The patients were divided into three groups:warm blood group(34～36℃ n=10);mild hypothermic group(25～29℃ n=10);hypothermia group(15～20℃ n=10).We measured serum creatine kinase CK at different times,and analyzed the blood gas from artery and venous as well as calculated oxygen undertaking.The changes of hemodynamic parameters were speculated and cardiomuscular biopsy was taken.Results In comparing the three groups,HR of the group with warm blood were slow after CPB stopped(P<0.05),HR of the hypothermia group were quick after CPB stopped(P<0.05).The changes of CK in the group of warm blood and mild hypothermia had no apparent differences,but the CK in hypothermia group had been apparently high after the coronary artery were reperfused for two hours(580±19ul/L),reached to peak(1018±52ul/L)at four to six hours.It also kept high level at 24 hours(890±52ul/L).The changes of CK in mild hypothermia group were similar to those in warm blood group,but the CK level was lower than in hypothermia(P<0.05)after reperfused for 24 hours.It showed that the damage of myocardium was significent.The mitochondria and myofilament had been destroyed severely in hypothermia than in the mild hypothermia group and in the warm blood group.The heart spontaneous rebeat rate both in mild hypothermia and warm blood groups were higher than in the hypothermia group(86.4% 79.8% vs 57.3% P<0.05).Conclusion Perfusion in mild hypothermia and warm blood groups was benefitial for protecting myocardium.Combined with clinical work,the mild hypothermia group was most benefit for protecting myocardium.