含血心脏停搏液对未成熟心肌保护作用的研究  

The protective effect of blood cardioplegia on immature myocardium

作　　者：刘连波[1] 张爱华[1] 

机构地区：[1]山东省泰安市妇幼保健院小儿心胸外科

出　　处：《临床小儿外科杂志》2015年第6期516-520,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨婴幼儿体外循环中不同比例含血心脏停搏液与STH、HTK心脏停搏液对未成熟心肌的保护作用，为完善婴幼儿先天性心脏病围手术期的心肌保护提供临床依据。方法选择100例先天性心脏病心内直视手术病例，年龄2个月至3岁。随机分为4：1含血停搏液组（A组）、1：4含血停搏液组（B组）、STH停搏液组（C组）及HTK停搏液组（D组），每组各25例。四组患者分别于体外循环前（t1）、体外循环结束时（t2）、主动脉阻断开放后24h（t3）、主动脉开放后72h（t4）采集中心静脉血，测定血浆中BNP、CK、CK—MB、cTnT的含量。结果同一组患者在各时间点心肌损伤指标各不相同，差异有统计学意义（P〈0．05）；同一时间点四组患者于体外循环前组问BNP、CK、CK-MB、cTnT血浆含量，差异无统计学意义（P〉0．05）。在主动脉开放、心肌再灌注后，各组患者在不同时间点心肌损伤指标比较，C组均高于其他三组，差异有统计学意义（P〈0．05）；A组、B组、D组之间心肌损伤指标血浆含量差异元统计学意义（P〉0．05）。结论两种含血心脏停搏液和HTK液对未成熟心肌的保护效果均优于STH液。对于简单先天性心脏病而言，体外循环时间短，含血心脏停搏液和HTK液对未成熟心肌损伤的保护作用无明显差异。1：4含血心脏停搏液，灌注操作简单方便，更易被临床医生接受，为婴幼儿未成熟心肌的保护提供了新的临床思路。Objetive To assess the protective effects of the STH solution,HTK solution and different proportion cold blood solution on infants myocardium. Methods 100 patients （2 months -3 years） with open-heart surgery of congenital heart disease were randomized into four groups. Group A was perfused with 4 ： 1 cold blood solution, group B with 1：4 cold blood solution, group C with STH solution, group D with HTK solution. Each group was given the corresponding cardioplegic solution. Plasma levels of b-type brain natriuretic peptide,creafine kinase, creatine kinase MB, plasma cardiac troponin were respectively measured before cardiopulmonary bypass（ tl ） , at the end of cardiopulmonary bypass（ t2 ） ,24 hours after aorta declamped （t3）and 72 hours after aorta declamped（t4）. Results The index of myocardial injury at each time point in the same group are not identical and the difference had statistically significant （P 〈 0.05 ）. There is no statistically significant difference between each groups in terms of the levels of BNP, CK, CK-MB, cTnT in plasma（ P 〉 0. 05 ） at the same time point among the four groups before cardiopulmonary bypass. After aorta declamped and myocardial reperfusion, myocardial injury index in each groups at different time points were different, and those index in group C were higher than in other three groups ,the difference had statistical significance （P 〈 0.05 ） ; there was no statistically significant difference in the myocardial injury index among group A, B and D （P 〉 0. 05 ）. Conclusions Two cold blood solution and HTK solution on immature myocardial protection effect is superior to STH. For simple congenital heart disease, the extracorporeal circulation time is short, there is no significant difference between cold blood solution and HTK solution in protecting immature myocardial. The 1：4 cold blood solution is more convenient and easier accepted by clinical physicians. Through this research, we provides a new clinical thought for young child immat

关 键 词：心肌 心脏病/先天性 体外循环 心脏停搏 

分 类 号：R726.5[医药卫生—儿科]