体外循环冠状动脉旁路移植术中采用微量晶体停搏灌注法与不停跳法的心肌保护效果比较  

Comparison of the myocardial protective effect of minimal cardioplegia vs heart-beating in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

作　　者：陈祥舟[1] 刘梅[1] 肖颖彬[1] 陈劲进[1] 陈柏成[1] 

机构地区：[1]第三军医大学附属新桥医院全军心血管外科研究所体外循环组,重庆400037

出　　处：《中国体外循环杂志》2015年第2期94-98,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨在冠状动脉旁路移植术（CABG）体外循环（CPB）中采用自行设计的微量晶体心肌灌注法与不停跳法心肌保护的临床效果。方法选择择期在CPB下行单纯CABG患者40例,根据心肌保护方式不同随机分为微量晶体灌注组（E组）和常规CPB不停跳组（C组）,每组各20例。于麻醉诱导后（T0）、CPB 30 min（T1）、CPB停机（T2）、术后6 h（T3）、术后12 h（T4）、术后24 h（T5）、术后48 h（T6）分别比较两组患者动脉血气K＋、红细胞比容（Hct）、乳酸（Lac）及磷酸肌酸激酶同工酶（CKMB）、心肌肌钙蛋白I（cTnI）浓度,记录术前一般情况、搭桥支数、CPB时间、手术时间、呼吸机使用时间、ICU停留时间。结果两组患者均顺利出院,无死亡病例。E组CPB时间及手术时间明显长于C组（P〈0.05）,T1-T2 E组K＋浓度显著高于C组（P〈0.01）;T1-T6各时间点两组患者CKMB、cTnI浓度均明显高于术前水平（P〈0.01或P〈0.05）,E组CKMB、cTnI浓度均比C组高,但组间比较没有统计学差异（P〉0.05）;各时间点两组间Hct、Lac浓度及术前一般情况、搭桥支数、呼吸机使用时间、ICU停留时间比较均无统计学意义（P〉0.05）。结论在冠心病CPB中采用微量晶体灌注法能获得与常规CPB不停跳相似的心肌保护效果,在临床中可以安全使用。Objective To investigate the difference in the myocardial protective effect between the minimal cardioplegia andheart-beating in patients undergoing coronary artery bypass graft（CABG） with cardiopulmonary bypass（CPB）.Methods Accordingto the different ways of myocardial protection, 40 patients in coronary artery disease undergoing CABG with CPB were included and ran-domized equally into two groups： experiment（E） group and control（C） group. E group we chose minimal cardioplegia with hyperpo-tassemia（potassium 20 mmol/ L） as the antegrade cardioplegia after aortic cross clamping, C group we chose conventional CPB withbeating heart. The concentrations of potassium, hematocrit（Hct）, lactate（Lac） from the arterial blood gas and plasma levels of cardi-ac Troponin I（cTnI）, creatine kinase MB（CKMB） were compared among two groups at following time point： preoperation（T0）, 30 min after CPB（T1）, end of CPB（T2）, 6 h（T3）,12 h（T4）,24 h（T5） and 48 h（T6） after surgery. Preoperative general situationand counts of graft, time of CPB, operation, mechanical ventilation and ICU stay were also collected.Results There was no hospitaldeath in either group. The time of CPB and operation in E group were obviously longer than C group（P〈0.05）; the concentrations ofpotassium in E group were significant higher than C group in T1 and T2（P〈0.01）; plasma levels of CKMB and cTnI were significanthigher than preoperation form T1 to T6 in two groups（P〈0.01orP〈0.05）; plasma levels of CKMB and cTnI in E group were higherthan C group, but there were not statistical difference between two groups form T1 to T6（P〉0.05）; there was no significant differencein the concentration of Hct, Lac and preoperative general situation and counts of graft, time of mechanical ventilation and ICU stay between two groups（P〉0.05）.Conclusion The minicardioplegia can provide comparative myocardial protective effect as conven-tional CPB with beating heart, and minicardioplegia ca

关 键 词：冠状动脉旁路移植术 体外循环 心肌保护 停搏液 

分 类 号：R654.2[医药卫生—外科学]