不同冠状静脉窦逆行灌注压力对心肌保护的临床研究  

The clinical research of different retrograde perfusion pressure through coronary sinus on myocardial protection

作　　者：姚昊[1] 王强 孙旭[1] 

机构地区：[1]南京大学医院附属南京鼓楼医院胸外科,南京210000

出　　处：《中国体外循环杂志》2013年第1期15-17,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的比较不同冠状静脉窦逆行灌注(RCSP)压力对行心脏双瓣置换术患者的心肌保护作用。方法 60例双瓣置换术患者随机分为A、B两组,每组30例。应用首次主动脉根部顺行灌注(ACP)联合后续RCSP的方式行心肌保护。A组逆灌压力为(30±2)mm Hg,B组逆灌压力为(40±2)mm Hg,对两组心肌保护的效果进行比较。结果 B组与A组相比,患者术后24 h多巴胺用量和机械通气时间均明显减少(P﹤0.05),血清肌酸激酶同功酶、乳酸脱氢酶和肌钙蛋白-I均明显减低(P﹤0.05)。A组患者术后出现低心排1例,其余两组患者均无任何并发症。结论在合理的逆灌压力范围内,40 mm Hg的逆灌压力对心肌保护效果优于30 mm Hg。Objective To compare the myocardial protective effects with different perfusion pressures of retrograde coronary sinus perfusion. Methods 60 cases suffering from bivalvular replacement were divided into 2 groups randomly, 30 cases for each group. Every patient was introduced to the myocardial preservation technique of primary aortic root antegrade perfusion combined with secondary retrograde coronary sinus perfusion. The retrograde perfusion pressure in group A was （30 ±2） mm Hg, and （40±2） mm Hg in group B. Different myocardial protective effects between these two groups were compared. Results Comparing to group A, the patients in group B had fewer dopamine usage and shorter mechanical ventilation time （ P 〈 0.05）, and the results of CKMB, cTn - Ⅰ and LDH were obviously lower. Only one patient had presented the low cardiac output syndrome in group A. Conclusion The retrograde perfusion pressure of 40 mm Hg can induce better myocardial protective effect than 30 mmHg.

关 键 词：体外循环 双瓣置换 逆灌 心肌保护 压力 

分 类 号：R654.2[医药卫生—外科学]