比较心脏不停跳与停跳行二尖瓣置换术心肌酶谱及线粒体的变化  

Comparison of changes of myocardial enzymes and mitochondrial in beating heart or cardiac arrest mitral valve replacement

作　　者：陈兵[1] 张骏[1] 陈昱[1] 陆中原[1] 李雄伟[1] 

机构地区：[1]解放军第117医院胸心外科,浙江杭州310013

出　　处：《临床军医杂志》2011年第2期250-252,共3页Clinical Journal of Medical Officers

摘　　要：目的比较心脏不停跳与停跳行二尖瓣置换术心肌保护的效果。方法将12例浅低温心脏不停跳二尖瓣置换术(BH)与12例冷晶体灌注心脏停跳下二尖瓣置换术(CCP)做比较,在麻醉后10 min,术后42、4、48、72 h这5个时点抽取周围静脉血测定血清CK、CK-MB、cTnI,MYO的变化。其中随机在BH组及CCP组各抽取10例,分别于体外循环(CPB)前和体外循环后取右心房心肌标本,在透射电子显微镜下观察线粒体形态并进行量化计分。结果 BH组术后各项指标虽较麻醉后增高,但增高幅度小于CCP组,在术后24 h均开始下降,72 h已基本接近正常。CCP组在术后24 h时各项指标除MYO外仍持续增高,72 h尚未恢复。体外循环后CCP组肌线粒体计分均高于BH组(P<0.01),BH组心肌超微结构优于CCP组。结论浅低温心脏不停跳较冷晶体灌注心脏停跳下行二尖瓣置换术具有更好的心肌保护效果。Objective To compare the effect of myocardial protection of beating heart and cardiac arrest mitral valve replacement.Methods Compared between 12 patients with mild hypothermia beating heart mitral valve replacement（BH） and 12 cases of cardiac arrest with the cold crystalloid perfusion mitral valve replacement（CCP）,blood serum was collected to determine the changes of CK,CK-MB,cTnI,MYO at 10 minutes after anesthesia and 4,24,48,72 h after surgery.10 patients in each group were selected randomly.Before and after cardiopulmonary bypass,right atrial myocardium specimens were obtained,observe the mitochondrial morphology by the transmission electron microscope and scoring.Results These parameters of BH group were increased after anesthesia,but the changes was less than that in CCP group,It began to decline at 24h after treatment and was quite close to the normal value at 72h.Parameters of CCP group were increased continuously at 24h after treatment except MYO and had not recovered at 72h.After cardiopulmonary bypass the muscle mitochondria of CCP group scoring was higher than that of BH group（P0.01）,the myocardial ultrastructure of BH group was better than that of CCP group.Conclusion The mitral valve replacement with mild hypothermia beating heart had a better myocardial protective effect than cold crystal cardiac arrest reperfusion.

关 键 词：心脏手术 浅低温 心肌保护 瓣膜置换 

分 类 号：R654[医药卫生—外科学]