心脏瓣膜置换术中不同心肌灌注方法的研究

Study on different myocardial protection methods in cardiac v alve replacement

目的 :对体外循环 (ECC)下瓣膜置换术中不同的心肌灌注方法进行比较 ,探讨各方法对心肌的保护效果及对围术期的影响。方法 :5 3例瓣膜手术按所采用的心肌灌注方法分为晶体停搏液组 (组Ⅰ ) ,含血停搏液组(组Ⅱ )和温血逆灌不停跳组 (组Ⅲ )。术前各组患者的一般临床资料均衡 ,但Ⅳ级心功者组Ⅱ (10 % )、组Ⅲ(15 4 % )多于组Ⅰ (0 0 % )。结果 :术中ECC时间、术后呼吸机使用时间、多巴胺支持率、引流量等各组之间无统计学差异 (P >0 0 5 )。组Ⅰ最低咽温、心脏自动复苏率、左室射血分数 (LVEF)明显低于组Ⅱ和组Ⅲ (P <0 0 5 ) ;ECC总液量、稀释度、晶体停搏液灌注量、血K+ 浓度均高于组Ⅱ和组Ⅲ (P <0 0 5 )。组Ⅲ主动脉阻断时间、ECC总液量低于组Ⅰ和组Ⅱ (P <0 0 5 ) ;流量和最低咽温高于组Ⅰ和组Ⅱ (P <0 0 5 )。与术前比 ,术后LVEF在组Ⅱ和组Ⅲ仅有轻微下降 (P >0 0 5 ) ,而组Ⅰ显著降低 (P <0 0 5 )。结论 :含血灌注和不停跳温血灌注能给心肌提供能量 ,因而较晶体停搏液具有更明显的心肌保护效果 ,且对围术早期的水。

Objective:To evaluated the effective of myoc a rdial protection of three perfusion methods in cardiac valve replacement under Extracorporeal Circulation (ECC) Methods: 53 patients were di vided into three groups. Group1 received cold crystalloid cardioplegia induction , group 2 were perfused with 4:1 blood cardioplegia, group 3 received continuous warm blood retrograde perfusion. Results: The total volume and hemodilution of group 2 and group 3 were lower than group 1, but the temperature was higher than group 1, there were significantly difference ( P <0 05) Th e perfusion volume of crystalloid cardioplegia and blood k + of group 1 wer e higher than group 2( P <0 05) The rate of auto resuscitation was lower t han group 2( P <0 05) The ECC total volume and aortic clam time in group3 w ere lower than that in group2 and group1 ( P <0 05) The post operative LVE F decreased slightly in group2 and group3 ( P >0 05), but decreased significa ntly in group1 ( P <0 05) Conclusion: crystalloid cardiople gia was convenient to use for myocardial protection, but it was not satisfied fo r sickly patients with dysfunction of left ventricle 4:1 cold blood cardiopleg ia and normal thermia ECC with retrograde perfusion without cardiac arrest can provide the energy for myocardial, therefore, it was benefit for valve replaceme nt