冷血与冷晶体停跳液在瓣膜置换术中心肌保护效果的比较  

Comparison of cold blood and cold crystalloid cardioplegia on myocardial protection effects in valve replacement surgery

作　　者：徐颖琦[1] 靳三庆[2] 肖颖[2] 张希[1] 姚尖平[1] 

机构地区：[1]中山大学附属第一医院心脏外科,广东广州510080 [2]中山大学附属第一医院麻醉科,广东广州510080

出　　处：《中国医师杂志》2006年第2期163-165,共3页Journal of Chinese Physician

摘　　要：目的 比较冷血液停跳液和冷晶体停跳液在心脏瓣膜置换手术中的心肌保护效果。方法 用回顾的方法，将近期由于风湿性心脏痛、心功能Ⅱ～Ⅲ级、成年患者、第一次行择期换瓣手术而分别使用冷晶体停跳液和冷血液停跳液各50例病人的术后心脏复跳情况、使用多巴胺情况、血压和心率变化情况、血清心肌酶水平、ICU住院天数等进行比较，以评价冷血液停跳液的心肌保护效果。2组停跳液的灌注条件相同且停跳后均使用心脏局部冰敷。结果 B组复跳时需用异丙肾上腺素的例数较C组为少（P〈0．05），2组病人手术后须电击除颤复跳的例数差异无统计学意义（P〉0.05）。术后多巴胺用量和血压、心率的稳定性差异无统计学意义（P〉0．05）。术后第1天心肌酶水平和ICU住院天数及手术结束到拔除气管导管的时间差异无统计学意义（P〉0．05）。结论 在心功能Ⅱ～Ⅲ级的病人行心脏瓣膜置换手术时，冷血停跳液与冷晶体停跳液具有基本相同的心肌保护效果。Objective To compare the myocardial protection effects of cold blood cardioplegia and cold crystalloid cardioplegia in patients undergoing valve replacement surgery. Methods One hundred adult patients with cardiac function Ⅱ～Ⅲ class undergoing primary elective valve replacement surgery due to rheumatic heart disease were retrospectively analyzed. For patients with cardiac arrest, cold blood cardioplegia was applied to 50 cases （Group B）, and cold crystalloid cardioplegia to the others （group C）. The process of heart resuscitation, the postoperative need of dopamine, the blood pressure and heart rate, the postoperative level of serum myocardial enzyme, the intensive care unit （ICU） stay after operation were collected and statistically analyzed. All the cardioplegic solution was perfused in a similar manner and topical cooling was employed simultaneously. Results There were less cases in group B than in group C who needed isoprenaline for cardiac resuscitation after clamp removal （ P 〈 0. 05 ）. There was no statistic significance in patients needed electric defibrillation and dopamine postoperatively, the blood pressure and heart rate perioperatively, the intensive care unit stay, the extubation time, and the myocardial enzyme release of the first day after operation between the two groups （ all P 〉0. 05）. Conclusion The cold blood cardioplegia and cold crystalloid cardioplegia have similar myocardial protection effects on rheumatic heart disease patients with cardiac function Ⅱ～Ⅲ class undergoing valve replacement surgery.

关 键 词：心麻痹液 低温 人工 心脏瓣膜假体植入 心肌 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]