温血诱导及终末温血灌注对心肌的保护作用

Myocardial protection of warm blood cardioplegia induction and reperfusion during cardiopulmonary bypass

目的 :评价温血诱导心脏停搏、术中冷维持及终末温血灌注对心肌的保护作用。方法 :44例首次瓣膜置换术病人 ,分为实验组 (n =2 1)和对照组 (n =2 3 )。实验组以常温含血停搏液诱导心脏停搏 ,再改为冷血停搏液 ,在主动脉开放前再次灌注常温含血半钾或全钾停搏液 ;对照组应用冷血停搏液灌注。围术期记录一些临床指标 ,两组各有 11例病人于CPB前、主动脉开放后 3 0min、主动脉开放后 6h、术后 2 4h ,4个时点采血测定血浆心肌肌钙蛋白 (cTnI)。结果 :实验组心脏自动复跳率明显高于对照组 (P <0 .0 5 ) ;cTnI于主动脉开放后 6h、术后 2 4h ,对照组明显高于实验组 (P <0 .0 5 )。结论 :温血诱导心脏停搏、术中冷维持以及终末温血灌注 (温 冷 温 )方法简单易行 。

Objective:To evaluate the myocardial protection of warm blood cardioplegia induction and reperfusion during cardiopulmonary bypass(CPB).Methods:Forty-four adult patients undergone valve replacement were devided into two groups:group T (21 cases) received warm blood cardioplegic induction and reperfusion,whereas group C (23 cases ) received cold blood cardioplegic only. The effect of myocardial protection of the two kinds of cardioplegic methods were evaluated in terms of clinical outcome and the plasma concentration of cardiac troponin I(cTnI). The samples were obtained before CPB,30 min,6 h after aorta unclamping,postoperative 24 h,respectively.Results:The rate of restoring spontaneous heart-beat in group T(95.24%) was significantly higher than that in group C(60.87%)( P<0.05). The plasma level of cTnI in group T was obviously lower than that in group C 6 h after aorta unclamping and postoperative 24 h.Conclusion:Warm blood cardioplegia induction and reperfusion during cardiopulmonary bypass provide better myocardial protection than simple cold blood cardioplegia.