体外循环中应用常温含血停搏液诱导停搏的心肌保护作用  

Myocardial protection of warm blood cardioplegic induction during cadiopulmonary bypass

作　　者：李庶[1] 郭杭珍[2] 常谦[3] 张东亚[4] 龙村[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院体外循环科,北京市100037 [2]北京电力医院麻醉科 [3]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院外科,北京市100037 [4]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院麻醉科,北京市100037

出　　处：《中华麻醉学杂志》2000年第3期152-155,共4页Chinese Journal of Anesthesiology

摘　　要：目的　评价在体外循环中常温含血停搏液诱导心肌停搏的心肌保护作用。方法　将2 8例成年瓣膜置换手术患者随机分为试验组 (T组 ,n =14)和对照组 (C组 ,n =14) ,T组以常温含血停搏液 (35℃～ 37℃ )诱导心肌停搏直至心电图 (ECG)为直线 ,再改用冷血停搏液 ;C组则直接以单纯冷血停搏液 (6℃～ 8℃ )诱导心肌停搏。分别于麻醉诱导后、停机、停机后 6小时、停机后 2 4小时采集动脉血、以ELISA法测定血浆中心肌肌钙蛋白T(cTnT)浓度、分别于冠脉循环阻断前及开放 10分钟取右心房肌组织 ,在H - 70 0 0透射电镜下观察心肌形态学。结果　 (1)临床效果 :T组自动复跳率(93% )明显高于C组 (5 0 % ) (P <0 0 5 ) ;需安装临时起搏器者 ,T组 1例 (7% ) ,C组 3例 (2 1% ) ,无显著性差异 (P >0 0 5 ) ;T组在围术期需没有使用多巴胺者 (0 % ) ,明显少于对照组的 5例 (36 % ) (P <0 0 5 ) ;术后拔除气管插管的时间及ICU停留时间T组亦明显短于C组 (P <0 0 5 )。 (2 )心肌生化 :在停机时和停机 6小时 ,T组血浆cTnT浓度明显低于C组 (P <0 0 5 )。 (3)心肌形态学 :T组明显优于C组。结论　在体外循环中应用常温含血停搏液诱导停搏 ,较单纯的冷血停搏液具有更明显的心肌保护作用。Objective To evaluate the myocardial protection of warm blood cardioplegic induction during cardiopulmonary bypass(CPB) Methods Twenty-eight adult patients undergoing valve replacement ,were devided randomly into two groups : in group test (group T,n=14) the warm (35℃-37℃) blood cardioplegia was infused to induce ECG straight line ,followed by the administration of the cold (6℃-8℃) blood cardioplegia , whereas in group control (group C ,n=14) the cold blood cardioplegia was applied simply The aterial blood samples were taken to measure the plasma concentration of cardiac troponin T (cTnT) with ELISA methods immediately after anesthesia induction,and immediately ,6 h, 24 h after the weaning from CPB The myocardial samples of right atrium were taken to observe the morphology with the transmission electron microscpe Results The rate of restoring spontaneous heart-beat in group T (93%) was significantly higher than that in group C (50%) One case in gruop T (7%) and three cases in group C (21%) required the interim pacemakers No case in group T (0%) and five cases (36%) in group C required the administration of dopamine perioperatively The durations of post-operative mechanical ventilative support and ICU-staying of group T were obviously shorter than those of group C The plasma level of cTnT in group T was obviously lower than that in group C immediately and 6 h after CPB Myocardial morphology in group T got much better outcome than that in group C did Conclusions Warm blood cardioplegic induction during CPB can provide better myocardial protection than cold blood cardioplegic induction

关 键 词：心肺转流术 心肌保护 心麻痹液 体外循环 

分 类 号：R654.1[医药卫生—外科学]