常温与低温心肺转流心肌损伤的比较  

Comparison of the effect of normothermic and hypothermic cardiopulmonary bypass on the myocardium protection

作　　者：马骏[1] 张培森[2] 王桂芝[1] 刘立群[3] 隽兆东[3] 高尔[1] 

机构地区：[1]山东省潍坊医学院麻醉系,潍坊市261042 [2]潍坊医学院附属医院 [3]山东省潍坊医学院外科学教研室,潍坊市261042

出　　处：《临床麻醉学杂志》2007年第5期399-401,共3页Journal of Clinical Anesthesiology

基　　金：山东省教育厅资助项目

摘　　要：目的比较常温和低温心肺转流(CPB)中的心肌损伤。方法成年健康杂种犬11只,随机分为低温组(H组,n=5)和常温组(N组,n=6)。H组采用4℃改良托马氏停搏液间断灌注,最低鼻咽温度28～30℃,N组采用氧合温血持续灌注,最低鼻咽温度35.3～37.1℃。主动脉阻断60min,CPB90min。分别测定CPB前、CPB30、90min、CPB后60min时静脉血心肌相关酶含量;CPB中心脏停跳时间和复跳时间;CPB后60min心肌含水量。结果两组天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)在CPB中和CPB后均较CPB前升高;且H组AST、HBDH、CK、CK-MB在CPB30、90min,CPB后60min均较N组升高;H组LDH在CPB90min、CPB后60min较N组高。主动脉夹闭后,H组的心脏停跳所需时间明显短于N组;主动脉开放后,H组的心脏复跳所需时间明显长于N组。CPB后60min心肌含水量H组高于N组。结论常温和低温CPB都可引起心肌组织损伤,尤以低温CPB为著。Objective To investigate the myocardial protection during normothermic or hypothermic cardiopulmonary bypass（CPB）. Methods Eleven dogs were randomly divided into hypothemic （H, n=5）and normothermic（N, n=6）two groups. The dogs in group H were infused by intermittent 4℃ crystalloid cardioplegia solution, and those in group N received continuous warm oxygenated cardioplegia blood. During CPB, the lowest pharyngonasal temperatures of group H and N were 28-30℃ and 35.3-37.1℃ ,respectively. Aortic clamping lasted for 60 min and CPB for 90 min. The levels of myocardial enzymes were measured before CPB, at 30 and 90 min during CPB and 60 min after CPB. The time interval for inducing cardiac arrest and spontaneous resuming heart beat were assessed. The water content of the myocardium was detected 60 min after CPB. Results The levels of AST, LDH, HBDH, CK and CK-MB increased during and after CPB. The levels of AST, HBDH, CK and CK-MB in group H were higher than those in group N at 30,90 min duning CPB and at 60 min after CPB. The level of LDH of group H was higher than that of group N at 90 min during CPB and at 60 min after CPB. The time interval for inducing cardiac arrest of group H was shorter than that of group N. But the time interval for spontaneous resuming heart beating of group H was longer than that of group N. The water content of the myocardium of group H was more than that of group N at 60 min after CPB. Conclusion CPB may result in myocardial injury, especially in hypothermic cardiopulmonary bypass.

关 键 词：心肺转流 温氧合血停搏液 冷晶体停搏液 心肌保护 心肌酶学 

分 类 号：R654.2[医药卫生—外科学]