浅低温心脏不停跳瓣膜置换手术的生化学研究  

Open heart surgery on beating heart under mild hypothermia

作　　者：吴海波[1] 何学志[1] 李继良[2] 敖定椿[2] 

机构地区：[1]大连市中心医院,116037 [2]大连医科大学附属第一医院

出　　处：《医师进修杂志（外科版）》2005年第6期13-15,共3页

摘　　要：目的通过监测分析浅低温体外循环心脏不停跳心内直视手术时,心肌组织中氧自由基和能量代谢情况以及血清中心肌酶学变化探讨更有效的心肌保护方法。方法风湿性心脏瓣膜病患者30例,随机分两组,每组15例。组Ⅰ:中度低温心脏停跳组,组Ⅱ:浅低温心脏不停跳组。各组于转机前、主动脉阻断钳开放即刻及开放后30min(不停跳组取相应时间)取少量右心耳全层心肌置液氮中保留,备测定丙二醛(MDA)、ATP和CP;另于术前、术后8h、16h、24h、48h取静脉血查心肌肌钙蛋白Ⅰ(cTnI)、CK及CK-MB。结果浅低温心脏不停跳组中各项指标均优于心脏停跳组。结论浅低温心脏不停跳手术由于明显地减轻了低温和缺血-再灌注损伤给心肌带来的损害,具有明确的心肌保护作用。Objective To investigate the myocardial protective effect in open heart surgery on the beating heart under mild hypothermia. Methods Thirty patients with congenital heart disease or acquired cardiac valvular disease were randomly divided into 2 groups. GroupⅠ: Moderate hypothermia ischemic cardiac arrest group (n=15), operations were performed during cardiopulmonary bypass(CPB) with ascending aorta being clamped,and cold cardioplegia(0～4 ℃) was infused. GroupⅡ: Open heart surgery on the beating heart under mild hypothermia. Hearts were kept beating during the repair in an unloading condition at mild hypothermia, While the arota was not clamped. The sample was incised and immersed immediately into liquid nitrogen for assays of malondialdehyde (MDA), ATP and CP at the times of CPB begins, ascending arota clamp removing and 30 minutes reperfusion (the time was set for groupⅡ accordingly). Serum was taken for assays of cardiac troponionⅠ(cTnI), CK and CK-MB at the time of preoperation, 8, 16, 24 and 48 hours after ascending aorta clamp removing. Results All indexes in groupⅡ were obviously superior to group Ⅰ. Conclusion Open heart surgery on the beating heart CPB at mild hypothermia may decrease myocardial damage if applied properly.

关 键 词：瓣膜置换手术 化学研究 浅低温心脏不停跳手术 风湿性心脏瓣膜病 缺血-再灌注损伤 浅低温体外循环 心肌肌钙蛋白Ⅰ 心肌酶学变化 心肌保护作用 心脏停跳 主动脉阻断 心内直视 监测分析 保护方法 能量代谢 氧自由基 心肌组织 

分 类 号：R654.2[医药卫生—外科学] R282.71[医药卫生—临床医学]