经冠状静脉窦逆行灌注在主动脉瓣置换手术中的应用

Application of retrograde coronary sinus perfusion in aortic valve replacement surgery

目的探讨经冠状静脉窦逆行灌注在主动脉瓣置换手术中心肌保护的有效性。方法纳入我院2016年1~12月行主动脉瓣置换手术患者58例,进行围术期心肌保护研究。根据术中心脏灌注停跳方式随机将患者分为两组:顺行性灌注组(对照组,n=26),主动脉根部或径冠状动脉开口顺行性灌注冷血心脏停搏液;顺+逆行灌注组(实验组,n=32),顺行灌注诱导心脏停搏,再经冠状静脉窦逆行灌注。观察两组患者早期临床疗效,围术期指标的变化情况。结果两组58例患者均安全度过围术期,未出现死亡及重要脏器损害等并发症。实验组手术效果更佳,术中心脏自动复跳率、复跳后ST段改变指标显著优于对照组,差异有统计学意义(P<0.05)。两组体外循环时间、主动脉阻断时间、术后血清肌钙蛋白I(c Tn I)、肌酸激酶同功酶(CK-MB)指标比较无显著性差异(P>0.05)。结论经冠状静脉窦逆行灌注在主动脉瓣置换手术中能够安全的应用,该方法心肌保护确切,且可避免损伤冠脉开口,避免因心肌肥厚或冠脉狭窄导致的术中灌注不足等严重并发症的产生。

Objective To investigate the effectiveness of retrograde coronary sinus perfusion in myocardial protection during aortic valve replacement. Methods 58 patients undergoing aortic valve replacement surgery in our hospital from January to December 2016 were selected. The study of perioperative myocardial protection was carried out. According to the way of intraoperative heart perfusion arrest, the patients were randomly divided into two groups： Anterograde in- fusion group（control group,n=26）, aortic root or diameter coronary artery anterograde perfusion of cold blood cardioplegic solution; anterograde＋retrograde perfusion group（experimental group,n=32）, antegrade perfusion-induced cardiac arrest, followed by retrograde perfusion via coronary sinus. The early clinical efficacy and the changes of perioperative indices were observed in the two groups of patients. Results All the 58 patients safely passed the perioperative period in both groups, and there were no complications such as death and vital organ damage. The experimental group had better operative effect. The intraoperative auto-rebeat rate of heart and changes of ST index after rebeat were significantly better than those in the control group, and the difference was statistically significant（P〈0.05）. There was no significant differ- ence in the levels of duration of ardiopulmonary bypass, time of aorta occlusion, postoperative serum troponin I（cTnI） and creatine kinase isoenzyme （CK-MB）between the two groups （P〉0.05）. Conclusion Retrograde perfusion via coronary sinus can be used safely in aortic valve replacement surgery. The method of myocardial protection is accurate, and can avoid damage to the coronary opening, avoid intraoperative hypoperfusion and other serious complications due to cardiac hypertrophy or coronary stenosis.