温氧合血诱导停搏及终末再灌注心肌保护的研究  

A Study on Myocardial Protection of Warm Oxygenated Blood Induced Cardiac Arrest and Final Perfusion

作　　者：郑俊猛[1] 王得坤[1] 孙培吾[1] 

机构地区：[1]中山大学附属第一医院

出　　处：《中山大学研究生学刊（自然科学与医学版）》2002年第1期11-16,共6页Journal of the Graduates Sun YAT-SEN University(Natural Sciences.Medicine)

摘　　要：目的:对比研究4℃冷晶体停搏液间断灌注和温氧合血诱导停搏及终末再灌注的心肌保护作用。方法:选择40例术前心功能Ⅲ-Ⅳ级(NYHA分级)需在体外循环下施行心内直视手术的风湿性心脏病患者,随机分成主动脉根部4℃冷晶体停搏液间断灌注的冷晶体组(n=20),主动脉根部温氧合血顺灌诱导停搏及终末再灌注,4℃冷晶体停搏液间断灌注维持停搏的温血组(n=20)。两组病例在性别、年龄、体重、手术种类、术前心功能、机器预充液、体外转流时问、主动脉阻断时间、开放时温度等均无显著差异。通过①临床观察心脏自动复跳率及复苏后心律紊乱情况;②测定停跳前、复跳后0、6、12、18、24小时的血浆心肌肌钙蛋白I(cThI),②停跳前及开放后10分钟取右心室流出道心肌活检,观察心肌超微结构改变及用FlaMeng线粒体半定量分析法对线粒体作量化计分。结果:①临床观察心脏自动复跳率,温血组(95%)明显高于冷晶体组(40%)(P<0.01)②体外循环后温血组血浆cTnI明显低于冷晶体组,温血组cTnI高峰出现时间(复跳后12小时)较冷晶体组(复跳后18小时)早;②线粒体量化计分分数反映复跳后心脏超微结构,温血组心肌损伤较冷晶体组轻。结论心脏自动复跳率、血浆CTnI、心肌超微结构改变及线粒体量化计分能反映心肌缺血及再灌注损伤。温氧合血诱导停搏及终末再灌注较冷晶体停搏液心肌保护效果为好。对心功能不全,心肌能贮低下的高危病例应采用温氧合血诱导停搏及终末再灌注。Objective: A comparative study was underwent on myocardial protection of intermittent 4℃ cold erystalloid cardioplegia and warm oxygenated blood induced cardiac arrest and final perfusion. Methods 40 rheumatic heart disease patients, which had Ⅲ-Ⅳ grade heart function (NYHA) and needed extracorporeal circulation and intracardiac operation under direct vision were random assigned to intermittent 4'C cold erystaUoid eardioplegia through aorta root (called cold crystaUoid group, n=20), or warm oxygenated blood inducing cardiac arrest intermittent 4℃ cold crystalloid cardioplegia perfusion and warm oxygenated blood final perfusion (called warm blood group, n=20). There were no significant differences between two groups in sex, age, weight, operative methods, heart function before operation, primining fluid in extracorporeal circulation, extracorporeal circulation time, aorta clamping time and temperature when opening. Prospective study was underwent on. 1. Rate of spontaneous resuming of heart beat and arrythmias after resuscitation. 2. The plasma cardiac troponin I (cTnI) was measured before ceasing of heart beat and at 0, 6, 12, 18, 24 hours after resuming of heart beat. 3. A piece of right ventricular outflow track myocardium was obtained before ceasing of heart beat and 10 minutes after opening of aorta damp to observe myocardial ultrastructure and analyzing mitochondria simiquantatively according to Flameng method. Results 1. Warm blood group had higher rate of spontaneous resuming of heart beat (95%) vs cold erystalloid group (40%) (p<0.01). 2. The plasma cTnI were obviously lower in warm blood group than that in cold crystalloid group after extraeorporeal circulation. The peak time of cTnI in warm blood group (12 hours after resuming of heart beat) was faster than that in cold erystalloid group (18 hours after resuming of heart beat). 3. Mitochondria simiquantative scores showed that myocardial ultrastructure were lightly damaged in warm blood group than that in cold crystalloid group. Conclusion Myoca

关 键 词：终末再灌注 体外循环 心肌保护 冷晶体停搏液 温氧保血停搏液 风湿性心脏病 

分 类 号：R541.2[医药卫生—心血管疾病]