浅低温体外循环不停跳心内直视术的心肌保护  

Protective effect of shallow hypothermia cardiopulmonary bypass in orthoptic cardiac surgery of beating heart on cardiac muscle

作　　者：缪冬梅[1] 周易[1] 甘玉芬[1] 

机构地区：[1]自贡市第四人民医院麻醉科,四川自贡643000

出　　处：《现代医药卫生》2006年第22期3408-3410,共3页Journal of Modern Medicine & Health

摘　　要：目的:探讨浅低温体外循环不停跳心内直视术的心肌保护。方法:30例心内直视术病人随机平均分为心脏停跳和不停跳两组。停跳组降温致食管温度(25±1.35)℃,并从升主动脉根部灌注冷高钾停跳液,灌注量15ml/kg,同时在心脏表面及心腔内冰盐水浸泡,致心脏停跳,阻断升主动脉。不停跳组降温至食管温度(31±1)℃,只阻断上下腔静脉,不阻断主动脉,控制心率在40～70次/分。结果:两组病例术中血液动力学均较稳定,差异无显著性。但两组CK-MB、CK、LDH、α-HBDH均较术前增高,尤以停跳组明显,两组比较差异有显著性。结论:心内直视术麻醉采用浅低温心脏不停跳体外循环技术对心肌具有较好的保护作用,但仍然存在需要进一步解决的问题。Objective：To investigate the protective effect of shallow hypothormia cardiopulmonary＇ bypass in orthoptic cardiac surgery of beating heart on cardiac muscle.Methods：30 patients enrolled for orthoptic cardiac surgery were divided into cardiac arrest group and beating heart group.ln the cardiac arrest group,the esophagus temperature was lowered to （25±1.35）℃ ,the eardiopleyia solution of cold and high potassium 15 ml/kg was infused into the root position of ascending aorta,and the heart surface and heart carity were soaked with ice brine at the same time for blocking the ascending aorta,which leaded to cardiac crrest.while esophagus temperature in the beating heart group was lowered to （33±0.8）℃,the superior vena cava and inferior vena cava were blocked,without blocking the ascending aorta,the heart rate was controlled at 40 to 70 times/minute.Results：The vital sign in both group was very, stable,without obvious difference between them,but all CK-MB,CK,LDH and 2-HBDH in both groups increased compared with those before operation with significant difference,especially in the beating heart group.Conclusion：Shallow hypathermia cardiopulmonary bypass in orthoptic cardiac surgery of beating heart has a good protective effect on cardiac muscle,but still existence problems demand to be further resolved.

关 键 词：心脏直视手术 体外循环 心脏不停跳 心肌保护 

分 类 号：R614[医药卫生—麻醉学]