心脏瓣膜手术中冷氧合血与冷晶体停跳液保护心肌作用的比较(附20例报告)  

Myocardial protection by cold blood and cold crystalloid cardioplegia during cardiac valve replacement operation

作　　者：满敏[1] 于灵芝[1] 王晓燕[1] 王萍[1] 李刚[1] 

机构地区：[1]山东省立医院,山东济南250021

出　　处：《山东医药》2002年第18期13-15,共3页Shandong Medical Journal

摘　　要：将 2 0例行心脏瓣膜置换术的患者随机分为两组 ,分别在体外循环期间采用冷氧合血停跳液及冷晶体停跳液。通过监测围术期、术后 2 4h的血流动力学变化 ,心脏自动复跳率及复跳时间 ,开放主动脉后 6h心肌肌钙蛋白 T(c Tn T)的变化 ,术后标准 导联心电图变化和临床强心药物使用率及患者在危重监测病房 (ICU)停留时间等 ,对比观察两组的心肌保护效果。结果 :冷氧合血停跳液组 (氧合血组 )的心脏自动复跳率及自动复跳时间优于冷晶体停跳液组 (冷晶体组 ) ;开放主动脉后 6h c Tn T含量少于冷晶体组 ,两组术中及术后 2 4h内血流动力学变化无差异。To observe myocardial protective effect of mixed hypothermic blood cardioplegia and hypothermic crystalloid cardioplegesia ,20 patients operatea on with valve replacement operation were randomly divied into 2 groups. Hemodynamic parameters were recorded during operation and 24 hours postoperatively. The rate and the onset time of automatically heart rebeating after aortic declamp. The changes of ECG on lead Ⅱ 24 hours postoperation ,the frequency of using inotrope , staying time in the ICU were analyzed. Blood samples were delivered for cTnT test before aortic clamp and 6 hours after reperfusion. The result showed that time of staying in the ICU had no significant difference between the two groups. Before aortic clamp cTnTs were all negative (less than 0.1ng/L). There was obviously increase after six hours reperfusion in both groups, especially in cold blood group in that cTnT level was significantly lower than that in crystalloid group (P<0.05). Compared with crystalloid group, there was less change of ECG in the cold blood group postoperation. This suggested that mixed hypothermic blood cardioplegia has better effect on myocardial protection than that of cold crystalloid one in cardiac valve operation.

关 键 词：心脏瓣膜手术 冷血停跳液 冷晶体停跳液 心肌保护 

分 类 号：R654.2[医药卫生—外科学] R614.27[医药卫生—临床医学]