单次和多次冷晶体血灌注对未成熟心肌保护的临床研究  

Study on single-dose and multiple-dose cold crystalloid hyperkalemic cardioplegia to protect the immature myocardium

作　　者：邓盛[1] 白韬[1] 熊荣生[1] 刘毅君[1] 李波[1] 许可[1] 张洁[1] 刘邕波[1] 

机构地区：[1]广西壮族自治区第二人民医院胸心血管外科,广西桂林541002

出　　处：《局解手术学杂志》2013年第2期148-150,共3页Journal of Regional Anatomy and Operative Surgery

基　　金：广西壮族自治区自筹经费科研课题(Z2006139)

摘　　要：目的探讨单次和多次灌注高钾冷晶体血停搏液对未成熟心肌的保护作用。方法 60名先天性心脏病婴幼儿,随机分成单次灌注高钾冷晶体血停搏液组(A组)和常规多次灌注冷晶体血停搏液组(B组),每组30名。于6个时相点采颈静脉和冠脉血,检测心钠素,降钙素基因相关钛,内皮素和肌钙蛋白,心肌酶。分别在心内操作开始和结束时取小块右房组织,电镜观察心肌超微结构。比较单次灌注高钾冷晶体血停搏液和常规多次灌注高钾冷晶体血停搏液对未成熟心肌的保护作用。结果 A组和B组术后心钠素,降钙素基因相关钛,内皮素,心肌酶均较术前增高,2组比较无统计学意义。2组心肌超微结构也无明显差异。结论对于主动脉阻断时间在60 min以内且无心电活动的手术,单次灌注与多次灌注冷血停跳液具有同样的心肌保护效果。Objective To investigate the effect of single-dose and multiple-dose cold crystalloid hyperkalemic cardioplegia on protecting the immature myocardium. Methods 60 infants with congenital heart disease were randomly divided into the single-dose cold crystalloid hyperkalemic cardioplegia group （group A） and multiple-dose cold crystalloid hyperkalemic cardioplegia group （group B）, each group with 30 cases. Jugular vein and coronary blood were collected at 6 points in time and detected the atrial natriuretic peptide and calcitonin gene-re- lated titanium, endothelin and troponin, cardiac enzymes. A small piece of right atrial organizations at the start and the end of surgery was clipped. The changes of myocardial ultrastructure were observed by electron microscopy. The experimental results of single-dose and multiple- dose cold crystalloid hyperkalemic cardioplegia were compared by statistical analysis. Results The postoperative atrial natriuretic peptide, calcitonin gene-related titanium, endothelin, serum creatine kinase of 2 groups were higher than those before operatiion. There was no signifi- cant difference in changes of myocardial ultrastructure structure of 2 groups. Conclusion Single-dose and multiple-dose cold crystalloid hy- perkalemic cardioplegia have the same protective effect for the surgery with aortic clamping time within 60 minutes and no electrical activity.

关 键 词：心肌保护 未成熟心肌 单次和多次冷晶体血灌注 

分 类 号：R542.2[医药卫生—心血管疾病]