风湿性心脏病瓣膜置换术中冷血间断和温血连续灌注心肌保护效果的比较  

Efficacy of cold-blood intermittent and warm-blood continuous perfusion in valve replacement for patients with rheumatic heart disease

作　　者：张正升[1] 赵根尚[1] 王喜明[1] 王寒[1] 何攀[1] 卯甜甜[1] 

机构地区：[1]郑州大学第二附属医院心血管外科,郑州450014

出　　处：《郑州大学学报（医学版）》2013年第4期527-530,共4页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:探讨风湿性心脏病瓣膜置换术中不同心肌保护方法对血清缺血修饰白蛋白(IMA)水平的影响。方法:将46例需行瓣膜置换手术的患者分为2组。A组术中采用温血连续灌注,B组采用冷血间断灌注。于术前、术中主动脉阻断5、30min,主动脉开放前,停机后及术后第1、3及5天取静脉血,测定心肌酶谱,通过IMA白蛋白钴结合试验(ACB试验)测定IMA水平,术后监测相关临床指标,比较2种心肌保护方法的效果。结果:主动脉阻断30min、开放主动脉前以及停机后A组IMA(ACB)值均高于B组(P<0.05);A组术后第1、3天心肌酶水平低于B组,第5天A组CK仍低于B组(P<0.05);A组自动复跳率较B组明显升高(χ2=13.200,P<0.001),辅助循环时间和气管带管时间也较B组明显缩短(t=2.406,2.234,P<0.05)。结论:温血持续灌注对心肌保护的效果优于冷血间断灌注组。Aim： To compare the efficacy of cold-blood intermittent and warm-blood continuous perfusion in valve replacement for patients with rheumatic heart disease.Methods： A total of 46 patients undergoing cardiac valve replacement operation were randomly divided into Group A and Group B.The traditional cold-blooded intermittent perfusion was used in Group B,and Group A adopted warm-blood continuous perfusion.The levels of myocardial enzymes were detected,and the serum content of ischemia modified albumin（IMA） was also be tested by albumin cobalt binding test before operation,at 5 min,30 min after aorta blocking,at the moment before aortic cross-release and after stopping cardiopulmonary bypass,and at the 1st,3rd and 5th day after the operation.Results： IMA in Group A at 30 min after aorta block,the moment before aortic cross-release,and after stopping cardiopulmonary bypass were higher than those in Group B（P0.05） .The serum levels of myocardial enzymes in Group A were lower than those in Group B at the 1st and 3rd day after the operation,and at the 5th day only the level of CK was still lower than that in Group B（P0.05） .The patients in Group A had a higher rate of spontaneous return of heartbeat,shorter auxiliary cycle time and shorter intubation time than Group B（χ2=13.200, t=2.406,2.234,P0.05） .Conclusion： Warm-blood continuous perfusion has better myocardial protection than coldblood intermittent perfusion.

关 键 词：温血连续灌注 心肌保护 缺血修饰白蛋白 白蛋白钴结合试验 冷血间断灌注 风湿性心脏病 瓣膜置换术 

分 类 号：R654.2[医药卫生—外科学]