冷氧合血与冷晶体停搏液对心脏瓣膜手术中心肌保护作用的对比研究  

Clinical Comparative Study of Myocardial Protection of Valve Surgery Patients with Cold Blood Cardioplegia and Crystalloid Cardioplegia

作　　者：谭思创[1] 胡建国[1] 周新民[1] 杨进福[1] 

机构地区：[1]中南大学湘雅二医院心胸外科,湖南长沙410011

出　　处：《中国医师杂志》2005年第10期1322-1324,共3页Journal of Chinese Physician

摘　　要：目的评价4∶1冷氧合血心脏停搏液同冷晶体停搏液在短主动脉阻断时间心脏瓣膜手术中的心肌保护作用。方法30例风湿性心脏瓣膜病变病人随机分为冷氧合血灌注组(实验组n=15)及冷晶体灌注组(对照组n=15)。术中主动脉根部灌注冷灌注液,观察主动脉阻断前和开放后6h心肌肌钙蛋白I(cTnI)、心肌肌酸激酶CK及其同工酶CK-MB、术后自动复跳率、10ws电除颤次数及辅助循环时间的影响和改变。结果⑴主动脉阻断前实验组与对照组cTnI、CK、CK-MB值无差异性,主动脉开放后对照组cTnI升高较实验组有显著性差异(P<0.05);⑵术后两组CK、CK-MB、自动复跳率、10ws电除颤次数、辅助循环时间无差异性。结论冷氧合血停搏液较冷晶体停搏液在成人瓣膜手术中有更好的心肌保护作用。Objective To compare myocardial protection between cold blood and crystalloid cardioplegia in short aortic cross-clamping （〈60min） valve surgery. Methods Thirty patients undergoing valve surgery randomized to receive intermittent antegrade cold blood cardioplegia （n=15） and erystalloid cardioplegia （n=15）. Blood samples were obtained from the central venous duct before cross-clamp application and 6 hours after cross-clamp removal for determination the contents of troponin -Ⅰ（cTnI）, creatine kinase（CK） and kinase isoenzyme MB（CK-MB）. Spontaneous resuscitation rate, times of 10ws depolarization in vivo and cardiopulmonary bypass （CPB） support time were observed at the same time. Results The postoperative cTnI level in cold blood group was significantly higher than that in crystalloid group（P〈0.05）, while the levels of CK and CK-MB, the spontaneous resuscitation rate, and the depolarization time were not significantly different between the two groups. Conclusion The cold blood cardioplegia showed better myocardial protection to patients undergoing short aortic-clamp time （〈60min） valve surgery than crystalloid cardioplegia.

关 键 词：心脏外科 心肌保护 心脏停跳液 心肌肌钙蛋白Ⅰ 心脏瓣膜病变 心肌保护作用 冷晶体停搏液 冷氧合血灌注 手术中 主动脉阻断时间 

分 类 号：R654.2[医药卫生—外科学] R657.4[医药卫生—临床医学]