4∶1液与微量晶体心停跳液在心内直视术中心肌保护的比较  

Comparison in Myocardial Protection of 4: 1 Blood Cardioplegia and Mini-Cardioplegia During Open Heart Surgery

作　　者：林乌拉[1] 陈秋荣[1] 阮秀璇[1] 陈金钗 张小霓[1] 陈瑜[1] 

机构地区：[1]福建省心血管病研究所

出　　处：《中华胸心血管外科杂志》1996年第4期204-206,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：９０例接受４∶１血液心停跳液和微量晶体心停跳液心肌保护心内直视手术病人，按设计的项目进行比较。阻断主动脉期间，两组病人冠状循环均连续灌注（顺灌或逆灌）从氧合器中引出并降温达８～１０℃的血液（红细胞压积０．２５左右）心停跳液，灌注量与速度相似。Ａ组（头２５例）用４∶１血液心停跳液连续灌注保护心肌；Ｂ组（后６５例）以高浓度晶体血液心停跳液连续灌注保护心肌。结果见两组病人术中心肌电机械活动抑制、心脏复苏、复苏后血液动力学稳定性、开放主动脉前冠状静脉血气分析、术后１、３、５天乳酸脱氢酶Ａ（ＬＤＨ－Ａ）检查均无明显差异。Ｂ组所用晶体停跳液量为Ａ组的５％（Ｐ＜０．０００１）；术中红细胞容积稳定，灌注装置简单，容量负荷低，停跳液用药少，是一种更理想的心肌保护法。Ninety cases received myocardial protection by 4:1 blood cardioplegia and mini-cardioplegia during open heart surgery were observed and compared according to designed items. During aortic cross clamping,the coronary vessels in patients of two groups were perfused (antegrade or retrograde) continuously with 8￣10℃ oxygenated blood(Hematocrit about 25%)cardioplegia from oxygenator.The volume and rate of perfusion were the same in two groups. Group A(first 25 cases) was perfused with 4 : 1 blood cardioplegia continuously. Group B (later 65 cases) was perfused with concentrated potassium cardioplegia solution. There were no significant difference between depressed myocardial electromechanical activity, cardiac resuscitation, hemodynamic stability after resuscitation, gas analysis of coronary veinous blood and results of LHDI examinations of 1、3、5 days postoperatively. These results suggested that two methods of myocardial protection are all safe and effective. But in group B,①The quantity of perfused crystalloid is just about 5%of group A (P< 0. 0001).②The hematocrit is stable during operation.③Both the set up of perfusion and the formula of cardioplegia are simple.④The volume used for perfusion is low. So the cardioplegia used in group B is a more ideal solution for myocardial protection.

关 键 词：心肌保护 心停跳液 心内直视手术 

分 类 号：R654.2[医药卫生—外科学]