晶体心脏停搏液优于血液心脏停搏液对风湿性心脏病患者的心肌保护  

Crystalloid cardioplegia is superior to blood cardioplegia for myocardial protection for rheumatic heart diseases

作　　者：陈长春[1] 姬尚义[1] 计乐群[1] 刘志红[1] 刘希伶[1] 胡应龙[1] 

机构地区：[1]广东省深圳市孙逸仙心血管医院,广东深圳518020

出　　处：《中国心血管杂志》2007年第1期9-12,共4页Chinese Journal of Cardiovascular Medicine

基　　金：深圳市科学技术局科技三项经费资助(编号:199906025)

摘　　要：目的比较血液心脏停搏液和晶体停搏液对风湿性心脏病患者心肌保护的效果，为临床选择提供依据。方法将75例择期手术的风湿性心脏病患者分为两组：血液心脏停搏液组（B-rh）和晶体心脏停搏液组（Grh）。分别于术前1d，术后1，3，5，8d晨分别取静脉血，测定血清天门冬氨酸氨基转氨酶（ASr），肌酸激酶（CK）及同工酶MB（CK—MB），乳酸脱氢酶（LDH）及同工酶1（LDH-1）。结果术前除B-rh的LDH略高于正常水平外其它心肌酶的测定结果均在正常范围；术后1d两组的心肌酶分别升高到术前的3～19倍（P〈0．05）；术后3d两组的CK—MB虽说已恢复到正常值，但五种心肌酶仍明显高于术前水平（P〈0．05）；术后5dC-rh的CK和CK—MB，B-rh的CK，CK—MB和AST与术前相比已无明显差别（P〉0．05）；术后8d两组的LDH与LDH-1仍未恢复正常（P〈0．05）。两组间有显著差异的心肌酶释放均是B-rh的高。心肌酶的释放量与主动脉阻断时间（CCT）和体外循环时间（ECCT）呈良好的正相关。两组患者的年龄，体重和ECCT无明显差异（P〉0．05），CCT以B-rh为短[（77．2±34．6）min比（61．7±26．7）min，P〈0．05]。结论从心肌酶的释放来判断，晶体心脏停搏液优于血液心脏停搏液对风湿性心脏病患者的心肌保护效果。Objective To compare the effect of myocardial protection between crystalloid and blood cardioplegia for rheumatic heart disease Method 75 patients dirided into two groups： blood cardioplegia group （B-rh） and crystalloid cardioplegia group （C-rh）, The venous blood samples from all patients were taken on the day before operation, postoperative day 1, 3, 5, and 8 to measure the serum content of AST, CK, CK-MB, LDH and LDH-1. Results Except LDH in B-rh was higher than normal, all enzymes before operation in two groups were within the normal range. On the 1st postoperative day, they peaked to three to nineteen times of those values preoperatively （P〈0.05）. On the 3rd postoperative day all the 5 cardiac enzymes in two groups were still significandy higher than those preoperative values （P 〈 0.05 ） although CK- MB had recovered to the normal range. CK, CK-MB in C-rh,CK,CK-MB and AST in B-rh had no significant differences compared with those preoperative values on the 5th day postoperatively. On the 8th postoperative day, LDH and LDH-1 in both groups were still significantly higher than their corresponding values measured before operation. If there was any statistical difference between two groups for any enzyme release, the higher group was B-rh. We also found that the release of myocardial enzymes was positively correlated with the aortic cross-clamping time （CCT） and extracorporeal circulation time（ECCT）. There were no significant differences between two groups for age, body weight and ECCT although CCT in B-rh is significantly shorter than that in Grh[ （61.7 ± 26.7）min vs（77.2 ±34.6）min, P 〈0.05]. Conclusion According to the release of 5 cardiac enzymes, crystalloid cardioplegia is superior to blood cardioplegia in the myocardial protection for rheumatic heart disease patients. LDH and LDH-1 should be used to evaluate the recovery of myocardium after ischemic and reperfusion injury.

关 键 词：风湿性心脏病 心肌酶 心内直视手术 体外循环 

分 类 号：R541.2[医药卫生—心血管疾病] R654.2[医药卫生—内科学]