两种心肌保护液在婴幼儿心脏手术中心肌保护临床效果的比较  

A comparative study of cold and warm cardioplegias in myocardial protection in infants

作　　者：辛梅[1] 倪尔连 金振晓[2,3] 赵凯[4] 刘刚[1] 欧阳辉[1] 张近宝[1] 

机构地区：[1]成都军区总医院心血管外科,四川成都610083 [2]成都军区总医院 [3]第四军医大学西京医院心血管外科,陕西西安710032 [4]成都军区总医院神经外科,四川成都610083

出　　处：《心脏杂志》2015年第3期335-339,共5页Chinese Heart Journal

摘　　要：目的:比较两种心肌保护液在婴幼儿术中心肌保护的效果。方法:36例体质量小于15 kg先天性心脏病患儿,随机分为A、B两组:A(n=18)组采用晶体:血液=1∶1冷血停跳液作为心肌保护液,B组(n=18)采用晶体:血液=1:4温血停跳液作为心肌保护液,分别于麻醉诱导前(T1)、升主动脉阻闭后5 min(T2)、开放后5 min(T3)、停机后5 min(T4)、术后1 h(T5)、术后24 h(T6)采集两组患者动脉血行炎性因子肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)检测;于T1、T5、T6、术后48 h(T7)采集两组患者动脉血行心肌酶谱及心肌损伤标记物检测。记录两组患儿术后呼吸机带机时间、转出ICU时间及手术死亡率、术后并发症发生情况。结果:两组患儿年龄、体质量、预充液组成、心肌保护液用量、体外循环时间、升主动脉阻闭时间、心肌保护液灌注次数等比较,均无显著性差异;B组患儿心肌保护液的血浆胶体渗透压明显高于A组[(14.9±0.8)mm Hg vs.(8.0±0.5)mm Hg,P<0.01);B组患儿心肌保护液的灌注压力明显低于A组〔(51±5)mm Hg vs.(107±8)mm Hg,P<0.01〕;开放升主动脉后心脏自动复跳率略高于A组(94%vs.89%),B组自动复跳时间明显短于A组〔(0.86±0.15)s vs.(8.63±0.95)s,P<0.01〕;体外循环期间,B组患儿尿量多于A组〔(43±6)ml vs.(29±11)ml,P<0.05〕;两组患儿围术期心肌损伤标记物血浆含量、TNF-α血浆含量无显著差异。炎性因子IL-8血浆含量在T2、T3、T4、T5、T6时,B组浓度明显低于A组,组间比较均有显著性差异(P<0.05,P<0.01);术后呼吸机辅助时间、ICU滞留时间两组比较无显著性差异。结论:温血心肌保护液可能会在一定程度上改善婴幼儿术中心肌保护效果,但是临床转归未达到显著差异。AIM： In the present study, we compared the effect of two kinds of cardioplegia on myocardial protection in infants. METHODS： Thirty six patients with congenital heart disease were enrolled in this trial, and all patients had a body weight 〈 15 kg. All patients were randomly divided into two groups： cold blood cardioplegia with 1 ： 1 ratio of crystal and blood was used as myocardial protective liquid in group A （ n = 18 ）, whereas warm blood cardioplegia with 1 ： 4 ratio of crystal and blood was used in group B. Some inflammatory factors like TNF-α and IL-8 were detected before induction of anesthesia （ T1 ）, at 5 min after aortic clamping （ T2 ）, 5 min after opening （ T3 ）, 5 rain after operation （ T4）, 1 h after operation （T5） or 24 h after operation （T6）, respectively. Myocardial enzymes and myocardial injury markers were detected at T1, TS, T6 and 48 h after operation （ T7 ）. Time of ventilation, ICU stay time, mortality and postoperative complications of both two groups were all recorded. Results ： There was no significant difference in the comparison of age, weight, priming solution composition, myocardial pro- tective liquid dosage, cardiopulmonary bypass time, aortic clamping time and myocardial protective liquid filling times between groups. Plasma colloid osmotic pressure of myocardial protection fluid was signifi- cantly higher in group B than in group A [ （ 14. 9 ± 0.8 ） mmHg vs. （ 8.0 ± 0.5 ） mmHg, P 〈 0.01 ]. Group B had lower cardioplegia perfusion pressure compared with group A [ （51 ± 5 ） mmHg vs. （ 107 ± 8） mmHg, P 〈 0. 01 ]. After opening ascending aorta, group B had higher automatic rebeating rate （94% vs. 89%） and shorter rebeating time than group A [（19.43 ±2.26） s vs. （64.86 ±2.72） s, P 〈0.01 ]. During cardiopulmonary bypass, patients in group B excreted more urine [ （43 _＋6） ml vs. （29 ＋ 11 ） ml, P 〈 0. 05 ]. There was no significant difference in regard to myocardial injury markers and TNF-

关 键 词：温血 冷血 心肌保护 婴幼儿 

分 类 号：R542.2[医药卫生—心血管疾病]