温氧合血心停搏液微流量连灌与微温氧合血间灌心肌酶谱变化的对比研究  

Comparative study of enzyme function of myocardium on warm oxygenated blood continuous perfusion and tepid oxygenated blood intermittent perfusion

作　　者：刘宁[1] 李建中[1] 刘伟[1] 李鹏[1] 何茂鑫[1] 高攀[1] 高飞[1] 

机构地区：[1]商丘市第一人民医院心血管外科,河南商丘476100

出　　处：《中国中医药咨讯》2010年第11期150-151,共2页

摘　　要：目的观察温氧合血心停搏液微流量连灌与微温氧合血间灌后心肌酶谱的变化。方法选择40例择期心脏瓣膜手术随机分为两组（每组20例）。A组采用常温CPB，温氧合血心停搏液（35℃）微流量连灌（0．5ml／mg．min）；B组采用浅低温CPB，微温氧合血心停搏液（26—28℃）间灌。主动脉阻断时间大于60分钟。分别测定术前、术后16、40、64、88h肌酸激酶（CK）、心肌型肌酸激酶同工酶（CK—MB）、乳酸脱氢酶（LDH）的变化，进行组内和组间对比研究。结果术后88h内，两组心肌酶均有不同程度升高，峰值多在术后16～40h，组内比较与主动脉阻断前差异有显著性（P〈0．05），大部分在88h内降至正常。组间比较，两组在大部分时间点差异有显著性（P〈O．05），B组心肌酶较A组低。临床结果证明，两组术后需循环和呼吸辅助时间短，心功能恢复迅速，稳定。结论微温氧合心停跳液间灌具有更好的心肌保护作用。Objective The study carried out to study the cardiac protection effect with the enzyme function of myocardium between continuous warm oxygenated blood cardioplegi.a（35 ℃ ） minimum-flow perfusion （group A 0.5ml/kg.min） and intermittent antegrade tepid （26-28℃）oxygenated blood cardioplegia perfusion （group B ）. Methods K total of 40 patients undergoing valve replacement was divided into two groups （20 pativnts each groups）;whose cross-clamped time were all more than 60 minutes were selected. Release of serum enzymes （CK, CK-MB and LDH） was determined preoperatively and at 16, 40, 64,and 88 postoperative hours. Results During the first 88 postoperative hours, the value of CK, CK-MB and LDH in two groups were different higher. Serum enzymes level increased significantly between 16--40hours after operation （P 〈 0.05）and return to mormal at 88 postoperative hours between two groups. But betweem two groups there is significant difference serum enzymes level of group B decreased than in the group A（P 〈 0.05）.Conclusion Iintermittent antegrade tepid blood cardioplegia is superior to continuous warm oxygenated blood cardioplegia during cardiac valve replacement in terms of myocardial protection.

关 键 词：心肌酶谱 连续灌注 间断灌注 含氧血心停搏液 温度 

分 类 号：R654.2[医药卫生—外科学]