末次温血停搏液在瓣膜置换术中的应用

MYOCARDIUM PROTECTION USING TERMINAL WARM BLOOD CARDIOPLEGIA IN OPERATION OF VALVE REPLACEMENT

目的 :评估末次温血停搏液灌注对瓣膜置换术患者的心肌保护作用。方法 :80例择期行瓣膜置换术的患者被随机分为 2组 ,对照组用间断冷血停搏液灌注 ,实验组用末次温血停搏液合并间断冷血停搏液灌注。分别于阻断前、体外循环停止后 30 ,6 0 ,12 0min记录平均动脉压、中心静脉压、肺毛细血管楔压、心输出量及心率 ,计算心脏指数 ,术前、开放升主动脉后 1,4 ,12 ,2 4 ,4 8h检测血浆肌酸激酶同工酶 (CK -MB) ,同时观察临床恢复情况。结果 :实验组术后多巴胺或多巴酚丁胺的平均最大剂量较对照组少 ,使用率低 ,CK -MB峰值显著低于对照组 (P <0 .0 1) ,自动复跳率高 (P <0 .0 5 ) ,停循环 2h的心脏指数显著高于对照组 (P <0 .0 1)。结论 :末次温血停搏液灌注对瓣膜置换术患者具有良好的心肌保护作用。

Objective:To evaluate clinical efficacy of the terminal warm blood cardioplegia reperfusion for myocardial protection in the patients undergoing valve replacement.Methods: Eighty patients undergoing elective valve replacement were randomly divided into intermittent cold blood and terminal warm blood cardioplegia groups. Mean arterial pressure, central venous pressure, pulmonary wedge pressure, cardiac output, heart rate were determined simultaneously before cross clamping and at 30, 60, 120 minutes after unclamping. The cardiac index was calculated. The serum creatine kinase MB was measured before clamping and at 1, 4, 12, 24, 48 hours after aorta opening unclamping.Results:In the terminal warm blood cardioplegia group, more inotropic support was needed after operation, the peak creatine kinase MB was lower ( P <0.01) ,the auto-beating ratio was higher( P <0.05),and the cardiac index at 2 hours after bypass discontinuing was significantly higher ( P <0.01).Conclusion:The terminal warm blood cardioplegia reperfusion is of benefit to the myocardial protection in patients undergoing valve replacement.