体外循环中应用中低温含血停跳液诱导停跳的心肌保护作用

The clinic study of myocardial protection with hypothermia warm blood cardioplegia in exreacorporeal circulation.

目的 比较温血心肌停跳液与冷晶体心肌停跳液在心脏瓣膜置换术中的心肌保护作用 ;评价体外循环间断温血停跳的心肌保护价值。方法 在24例心脏瓣膜置换术中分别采用温血灌注 (Ⅰ组 )和冷晶体灌注 (Ⅱ组 ) :每组各12例 ,进行心肌保护临床观察。Ⅰ组先用4 :1温血停跳液灌注心脏停跳 ,以后每隔20min用冷血停跳液灌注一次 ,保持心肌低温 ,在心脏复跳前再用温血灌注。Ⅱ组为应用4℃冷晶体心肌停跳液灌注 ,每隔20min灌注1次。结果 I组心脏自动复跳率明显高于Ⅱ组 (P<0.01) ,术后低心排征发生率明显低于Ⅱ组(P<0.05) ,术后应用心肌正性药物量及时间明显少于Ⅱ组 (P<0.05)。在停机时和停机6h ,Ⅰ组心肌肌钙蛋白明显低于Ⅱ组 (P<0.05) ,24h后心肌磷酸激酶CK,I组明显低于Ⅱ组 (P<0.05)。结论

Objective To compare the different effect of myocardial protection with warm blood cardioplegia and cold crystalloid cardioplegia during the valve replacement operations and to evaluate the myocardial protection of intermittent warm blood cardioplegia. Methods In order to observe the myocardial protection,24patients of valve veplacement operations were divided into two groups:patients of group1(n=12)were perfused with4:1warm blood cardioplegia to make cardioplegia firstly,then4℃cold crystalloid cardioplegia was perfused every20min to keep myocardial hypothermia and warm blood cardioplegia was perfused before heart rebeat.patients of groupⅡ(n=12)were perfused with4℃cold crystalloid cardioplegia and reperfused with it20minutes intervals. Results The heart automatic rebeatic rate in group I was significantly higher than those of groupⅡ(P<0.01).The post-operative incidence of lowcardiac output was signficantly lower than those of groupⅡ(P<0.05).The dosage and time of inotropic drug were significantly less than groupⅡ(P<0.05)Plasma levels of cTnT of group I were obviously lower than those of groupⅡat immediately and6hours after CPB(P<0.05).CK levels of group I were lower than those of group II after reperfusion for24hours(P<0.05) Conclusion Warm blood cardioplegia could provide better myocardial protection than cold crystalloid cardioplegia.