逆行灌注心脏跳动中带主动脉瓣人工血管升主动脉替换术治疗升主动脉瘤

Artificial vascular ascending aorta with aortic valve replacement surgery in the treatment of ascending aortic aneurysm with retrograde coronary sinus perfusion in beating heart

目的探讨逆行灌注心脏跳动中带主动脉瓣人工血管升主动脉替换术(Bentall)治疗升主动脉瘤经验及心肌保护效果。方法56例升主动脉瘤患者,分别采用心脏不停跳(不停跳组,30例)及心脏停跳(停跳组,26例)手术,主要检测各时点肌钙蛋白(TropninⅠ)、肌酸激酶同工酶MB(CK-MB)浓度及心肌丙二醛(MDA)含量。应用SPSS 10.0统计软件进行分析。结果两组TropninⅠ血清浓度在主动脉开放15 min后各时点均明显升高,但不停跳组明显低于停跳组(t=8.186,P<0.01;t=6.105,P<0.01;t=7.950,P<0.01;t=6.223,P<0.01);CK-MB在主动脉开放15 min后各时点均明显升高,在主动脉开放15 min、术后2 h及术后1 d 3个时点,不停跳组明显低于心脏停跳组(t=3.827,P<0.01;t=5.778,P<0.01;t=3.456,P<0.01)。心肌MDA浓度在停机时,不停跳组明显低于停跳组(t=2.761,P<0.01),两组在手术时间、体外循环时间、术后出血量及人工瓣膜瓣周漏等发生率差异无统计学意义(t=0.352、0.328、0.905,P<0.05)。结论Bentall手术可在逆行灌注心脏跳动中进行,且具有更好的心肌保护效果。

Objective To summarize the experience and myocardial protection of ascending aortic aneurysm treatment using Bentall operation with retrograde coronary sinus perfusion in beating heart.Methods A total of 56 cases of ascending aortic aneurysm were treated by surgery with beating heart or cardioplegia.The levels of tropninI,creatine kinase isoenzyme MB(CK-MB)and malondialdehyde(MDA)at different time points were detected.Statisticalanalysis of data using the statistical product and service solutions 10.0 software.Results TropninⅠserum concentration of both group were significantly increased at 15 min after aortic opening and all time points afterwards(P<0.01),but the beating-heart group was significantly lower than that of cardioplegia group(P<0.01);CK-MB concentration of both group were significantly increased at 15 min after aortic opening and all time points afterwards(P<0.01),but the levels of beating-heart group were significantly lower than the cardioplegia group at 15 min after aortic opening,2 hour and 1 day after surgery(P<0.01,P<0.05).When the bypass machine was turned off,the myocardial MDA concentration of the beating-heart group was significantly lower in the cardioplegia group(P<0.01).There was no significant difference in the operation time,cardiopulmonary bypass time,postoperative bleeding volume and prosthetic valve circumferential leakage between the two groups.Conclusion Bentall operation can be carried out with retrograde coronary sinus perfusion in beating heart,which demonstrated better myocardial protective effect.