浅低温体外循环心脏跳动中二尖瓣替换术的临床应用

Mitral valve replacement under beating heart with low dose temperature extracorporeal circulation

为评价浅低温体外循环 (CPB)心脏跳动中二尖瓣替换术的疗效及其对心肌的保护作用 ,将 30例二尖瓣狭窄并关闭不全患者随机分为两组各 15例。非停跳组在浅低温 (31～ 33℃ ) CPB心脏跳动中行二尖瓣置换术 ,停跳组采用传统心脏停跳法行瓣膜置换术。非停跳组术后病情平稳 ,多巴胺用量 0～ 5μg/ (kg· min) ,少于停跳组3～ 10 μg/ (kg· min) ,P<0 .0 1;无低心排出量综合征、严重心律失常及气栓栓塞等严重并发症。停跳组术中并发低心排综合征 1例 ,频发室性早搏 2例。术中二尖瓣置换后及术后 4小时 ,停跳组血清心肌酶含量较非停跳组显著增加 (P<0 .0 1)。认为浅低温 CPB心脏跳动中二尖瓣置换术是一种安全、有效。

To evaluate the curative effect and myocardial protective effect of extracorporeal circulation with low dose temperature(31℃ to 35℃)for heart valve replacement in beating heart 30 patients of mitral valve stenosis and infufficiency were divided into two groups In test group,mitral valve replacement was performed in beating heart under extracorporeal circulation with low dose temperature without application of cardioplegier,without aovtic block In control group,mitral valve replacement was performed with traditional method After operation, all test group patients had a good recovevy and did not develope any serious arrythia or low output syndrome or embdlism of gas embdus Dopamine was used 0～5μg/(kg·min) Comparing the content of CK and LDH of the two groups,the different content of CK and the different content of LDH have sighificance after mitral valve replacement and after operation Extracorporeal cirulation with low dose temperature for heart valve replacement in beating heart is a simple,safe and appliable myocardia protection which is close to physiological state