体外循环心内手术主动脉开放前纯温血灌注的心肌保护效果  

Myocardial protective effect of pure prime blood perfusion before aorta unclamping during open hrart surgery

作　　者：刘麟[1] 顾天玉[1] 陈金凤[1] 

机构地区：[1]南通市第一人民医院麻醉科,226001

出　　处：《江苏医药》2009年第10期1163-1165,共3页Jiangsu Medical Journal

摘　　要：目的探讨纯机器氧合血灌注诱复的心肌保护效果。方法40例重症心脏瓣膜置换术患者均分两组,A组开放主动脉前用温血停搏液灌注+纯机器氧合血顺-逆灌注,待心脏复苏后再开放升主动脉;B组开放升主动脉前单用温血停搏液灌注后即开放升主动脉。于转流前、术毕、术后6h和1、3、5d取外周血测定心肌肌钙蛋白I(cTnI),记录心脏复跳、主动脉阻断、辅助循环、机械通气和ICU停留时间。结果两组术后cTnI均较转流前增高,A组增高明显少于B组(P<0.01);A组自动复跳率高于B组,辅助循环、机械通气和ICU停留时间均短于B组(P<0.05)。结论主动脉开放前纯温血顺-逆灌注诱复后再开放方法有较好的心肌保护作用。Objective To study the myocardial protective effect of pure prime blood perfusion before aorta unclamping during open hrart surgery under cardiopulmonery bypass （CPB）. Methods Fourty patients undergoing cardiac valve replacement were divided into two groups with 20 cases each. The myocardium in group A was perfused with warm blood myocardioplegia plus pure prime blood before aorta unclamping and that in group B with warm blood myocardioplegia only. Serum troponin-Ⅰ（cTnI） was detected before CPB, at the end of operation, 6 h after operation and on the 1st , 3rd, and 5th postoperative day. The recovery of heart beating and the times of aorta occlusion,assistant circulation,mechanical ventilation and ICU stay were recorded. Results Compared with before CPB, cTnI after CPB was increased in both groups,but the increase of cTnI after CPB was significantly less in group A than that in group B （P〈0.01）. Autoreeovery rate of heart beating was higher in group A than that in group B and the times of assistant circulation, mechanical ventilation and ICU stay were shorter in group A than those in group B （P〈0.05）. Conclusion Myocardial infusion with warm blood myocardioplegia plus pure prime blood before aorta unclamping is effective for protecting the myocardium in the patients undergoing cardiac valve replacement.

关 键 词：心脏瓣膜置换 心肌保护 温血灌注 

分 类 号：R654[医药卫生—外科学]