心脏不停跳法与温血停搏液连灌法心肌保护作用的研究  

Comparative study of the myocardial protective effects of "beating heart" and continuous administration of warm blood cardioplegic solution with cardiopulmonary bypass

作　　者：林辉[1] 叶宁[1] 何巍[2] 郑宝石[2] 冯旭[2] 冼磊[2] 

机构地区：[1]广西壮族自治区人民医院胸心外科,南宁530021 [2]广西医科大学附属第一医院胸心外科

出　　处：《中华实验外科杂志》2002年第3期205-207,共3页Chinese Journal of Experimental Surgery

摘　　要：目的　探讨浅低温体外循环心脏不停跳法与温血心脏停搏液连续灌注法的心肌保护效果。方法　随机选择进行二尖瓣置换术的风湿性心脏病患者 2 0例 ,分成A组 (心脏不停跳组 )和B组 (温血心脏停搏液连续灌注组 )。检测血液的乳酸 (LA)、肌钙蛋白 (cTn T)、内皮素 (ET 1 )、丙二醛 (MDA) ;观察术后多巴胺等正性肌力药物使用和心排量 (CO)、心律失常等情况。结果　转机后血液生化各项指标均增高 ,差异有显著性 (P <0 .0 5) ,B组比A组明显增高 ;停机时和术后 1hA组的CO比B组增加 (P <0 .0 1 )。B组的多巴胺用量比A组明显增加 ,差异有非常显著性(P <0 .0 1 ) ,心律失常率增 ,有 3例需用临时起搏器 ;两组均无死亡。结论　术中心脏从停跳的灌注状态恢复到心脏跳动中的灌注状态 ,也存在再灌注的问题。A组各项生化指标 ,心功能恢复和临床情况 。Objective To study and evaluate the effects of myocardial protection of 'beating heart'and of continuous administration of warm blood cardioplegic solution during extracorporeal circulation with mild hypothermia.Methods Twenty patients with rheumatic heart disease undergoing operation of mitral valve replacement were divided into group A (beating heart group) and group B (warm blood cardioplegia group with continuous heart perfusion).Blood lactate (LA),cardiac troponin T (cTn T),endothelin 1 (ET 1),malondialdehyde (MDA) were measured.The dopamine usage,cardiac output (CO) and arrhythmia after operation were observed.Results All of the biochemical values were increased in the group B as compared with those in the group A after CPB (P<0.05).CO in the group A was higher than in the group B (P<0.01) when stopping CPB and 1 h post operation.Dopamine usage and arrhythmia occurrence in the group B were increased as compared with that in the group A  (P<  0.01). Conclusion All of the biochemical values and recovery of heart function and clinical conditions in the group A were superior to those in the group B.

关 键 词：心脏不停跳法 温血停搏液连灌法 心肌保护 浅低温 体外循环 

分 类 号：R654.2[医药卫生—外科学] R654.1[医药卫生—临床医学]