顺逆灌结合开放前温血灌注在冠状动脉旁路移植术中的心肌保护作用  

The myocardial protective effect of antegrade/retrograde cardioplegia combined with warm blood retrograde before reperfusion in coronary artery bypass graft

作　　者：王永旺[1,2] 薛玉良[1] 王凯元[1] 

机构地区：[1]泰达国际心血管病医院麻醉科,天津市300457 [2]天津医科大学研究生院

出　　处：《临床麻醉学杂志》2011年第8期787-789,共3页Journal of Clinical Anesthesiology

摘　　要：目的回顾研究顺逆灌结合开放前温血灌注在冠状动脉旁路移植术（CABG）中的心肌保护作用。方法择期CABG患者312例，男220例，女92例，年龄29-80岁（平均62岁）；其中顺逆灌结合温血灌注188例（研究组），间断顺灌124例（对照组）。研究组采用顺行灌注2min冷血停搏液600ml，再逆行灌注2min停搏液400ml，之后每隔10min进行顺逆灌各1min停搏液200ml，在开始吻合前降支时持续温血逆灌300ml／min直至开放。记录搭桥数、心脏自动复跳率、CPB时间、主动脉阻断时间、机械通气时间、ICU停留时间、住院天数。结果研究组CPB时间、机械通气时间、住院天数明显短于对照组（P〈0．05）。结论cABG中采用顺逆灌结合开放前温血灌注的心肌保护效果优于常规间断顺灌方法，值得临床推广。Objective To study the effects of antegrade/retrograde cardioplegia combined with Warm blood retrograde before reperfusion in coronary artery bypass graft surgery. Methods A total of 312 patients, including 220 males and 92 females, aged 29-80 years, scheduled for coronary artery bypass graft surgery were divided into two groups：antegrade/retrograde cardioplegia combined with warm blood retrograde group（group B, n= 188） and intermittently antegrade group（group C, n = 124）. In group B, 600 ml antegrade cold blood cadioplegia and 400 ml retrograde cardioplegia was firstly infused, followed by 200 ml intermittent antegrade cold blood cardioplegia and retrograde cardioplegia infusing every 10 min. When anastomosing anterior descending branch was begun, retrograde warm blood was infused at the rate of 300 ml/min before releasing aortic cross-clamp. The number of grafts, the incidence of spontaneous resuscitation, duration of CPB and mechanical ventilation, and the intensive care unit and hospital length of stay were evaluated. Results The mechanical ventilation, CPB time and mean hospital days in group B was significantly lower than in group C （P〈 0. 05）. Conclusion In CABG, the application of antegrade/retrograde cardioplegia combined with warm blood retrograde before releasing aortic cross--clamp is safer and more effective than the conventional intermittent antegrade in myocardial preservation.

关 键 词：心肺转流 心肌保护 冠状动脉旁路移植术 心脏温血灌注 

分 类 号：R654.2[医药卫生—外科学]