心脏跳动下手术对心肌保护作用的临床研究

Effects of Beating Heart Surgery on Myocardial Protection in Patients with Congenital Heart Disease

目的评价心脏不停跳手术对先天性心脏病患者心肌保护作用的效果。方法房间隔缺损(ASD),肺动脉瓣狭窄(PS)和室间隔缺损(VSD)患者共52例,随机分为实验组(不停跳组)和对照组(停跳组)。实验组在体外循环(CPB)浅低温(31—34℃)、心脏跳动状态下施术;对照组在冷晶体停跳、中度低温(28—30℃)CPB下手术。分别在术前、术后2、6、24h采集血标本,检测血清中乳酸脱氢酶(LDH)、天冬氨酸氨基转移酶(AST)、超氧化物歧化酶(SOD)活性和丙二醛(MDA)、心肌钙蛋白I(cTnI)含量;分别在心内操作开始和结束时剪取小块右房组织,电镜观察心肌超微结构变化;同时观察术中CPB时间和阻断时间)。结果不停跳组CPB时间较停跳组短(P<0.01),腔静脉阻断时间长于停跳组主动脉阻断时间(P<0.05)。不停跳组术后LDH、AST活性低于停跳组,SOD活性高于停跳组,MDA、cTnI含量低于停跳组。心内操作完毕后不停跳组较停跳组心肌超微结构变化小,线粒体肿胀轻。结论 心脏不停跳手术对先天性心脏病患者心肌具有更好的保护作用。

OBJECTIVE To evaluate the protective effects of beating heart in patients with congenital heart disease (CHD).METHODS 52 CHD patients were randomly divided into two groups: experimental group(n = 26) , received surgery on beating heart with mild hypothermia(31~34℃) cardiopulmonary bypass (CPB) ; control group (n =26) , received operation on arrested heart with moderate hypothermia(28~30℃)CPB. Blood samples were taken and the levels of aspartate aminotransferase(AST) , lactic dehydrogenase(LDH) , supefoxide dismutase(SOD) , and the content of ma-londiaehyde (MDA) , cordial troponin I(cTnI)were detected. Samples were taken from right atrium for observing ultra-structural changes. RESULTS Postoperatively, the activity of AST, LDH and the level of MDA ,cTnI were lower in experimental group than those in control group, whereas the activity of SOD was higher. The myocardial ultrastructural changes were significant by in less experimental control group, The CPB time of experimental group were shorter than that of control group( P < 0. 01) , however the vena cava occulation time was longer in experimental group ( P < 0. 05 ). CONCLUSION The myocardial protection effect of beating heart surgery with mild hypothermia cardiopulmonary bypass (CPB) was better than that on arrested heart with moderate hypothermia CPB.