体外循环阻断与不阻断升主动脉心内直视术临床研究  

Clinical Study of Cardiopulmonary Bypass Open Heart Surgery with and without Ascending Aorta Cross-clamping

作　　者：李军朋[1] 王军[1] 张会军[1] 解启莲[1] 申红[1] 赵友为[1] 赵剑[1] 高义[1] 

机构地区：[1]河北医科大学第一医院心脏外科,石家庄050031

出　　处：《医学研究杂志》2010年第3期117-120,共4页Journal of Medical Research

摘　　要：目的对比分析体外循环不阻断升主动脉不停跳心内直视手术、不阻断升主动脉停跳心内直视手术、阻断升主动脉心内直视手术的心肌保护效果。方法 45例先天性心脏病患者,随机选择分为不阻断升主动脉不停跳组(n=15),不阻断升主动脉停跳组(n=15),阻断升主动脉组(n=15)。比较心肌细胞三磷酸腺苷含量、血浆丙二醛和心肌钙蛋白Ⅰ浓度,以及电子显微镜下对比观察心肌细胞超微结构。结果阻断升主动脉组心肌细胞三磷酸腺苷含量、血浆丙二醛浓度、血浆心肌钙蛋白-Ⅰ浓度均小于不阻断升主动脉停跳组和不阻断升主动脉不停跳组,后两组比较无统计学差异;电子显微镜下观察发现阻断组心肌细胞超微结构破坏较为严重,而不阻断升主动脉停跳组和不阻断升主动脉不停跳组心肌细胞超微结构基本正常。结论体外循环不阻断升主动脉心脏跳动或停跳下行心内直视术具有较好的心肌保护作用。Objective To compare the myocardial protection effect in eardiopulmonary bypass （CPB） operation of congenital heart disease （CHD） in terms of with ascending aorta cross - clamping or non - clamping, with the heart beating or non - beating. Methods Of 45 CHD patients, 15 received corrective procedure with ascending aorta cross - clamping, 15 received operations without ascending and with heart bearting, and 15 received operations without ascending and with heart non -bearting. Malondialdehyde （MDA） and cardiac troponin - I （ cTn - I ） in plasma were measured. Right atrium myocardial tissues were taken for the observation of ultura - structure and measurement of adenosine triphosphate （ ATP）. Results Regarding the levels of MDA, cTn - I and ATP, the non - clamping groups were significantly higher than clamping group, but between the non- clamping groups with or without heart beating, there was no difference. The results of myocardial ultrastrcture was allmost normal in the non - clamping groups, but showed damaged in the clamping group. Conclusion Heart surgery without ascending aorta cross - clamping, no matter with or without heart beating, had superior myocardial protection than that with ascending aorta cross - clamping.

关 键 词：心内直视术 心肌保护 升主动脉 不阻断 不停跳 

分 类 号：R654.2[医药卫生—外科学]