心脏手术中温血心脏停搏液微流量连灌心肌保护效果的研究  

Comparison of myocardial protective effects of micro-dosecontinuous warm blood cardioplegia perfusion and intermittent cold blood cardioplegia perfusion.

作　　者：付庆林[1] 陈忠堂[2] 王海永[3] 法宪恩[3] 庄世才[3] 

机构地区：[1]山东大学医学院,山东济南250012 [2]济南市中心医院 [3]郑州大学第二附属医院

出　　处：《山东医药》2003年第6期7-10,共4页Shandong Medical Journal

摘　　要：为提高心脏手术中心肌保护的效果 ,将 2 0例风湿性心瓣膜病手术患者随机分为温血组与冷血组。温血组术中采用温血心脏停搏液微流量连续灌注、冷血组采用冷血心脏停搏液间断灌注行心肌保护。检测两组体外循环主动脉开放后即刻、主动脉开放后 6、12、2 4、72小时血清心肌肌钙蛋白 I( c Tn I)值 ;术中切取心房肌肉标本 ,电镜下观察超微结构变化 ,对比评价心肌保护效果。结果术前及主动脉开放即刻两组血清 c Tn I无显著性差异( P>0 .0 5 ) ;主动脉开放后 6、12、2 4、72小时温血组 c Tn I均显著低于冷血组 ,P<0 .0 1;超微结构检测示温血组心肌纤维及线粒体损伤显著轻于冷血组。To improve the myocardial protective effect,20 patients with rheumatic heart valvular disease were randomly divided into two groups[micro dose continuous warm blood cardioplegia perfusion group (MCWC) and intermittent cold blood cardioplegia perfusion group (ICBC)],10 patients in each group.Microdose continuous warm blood cardioplegia perfusion was used in MCWC,and intermittent cold blood cardioplegia perfusion was used in ICBC as myocardial protective methods.Cardiac troponin I (cTnI) was detected and the atrial muscle biopsies were incised for observation of myocardial ultrastructure under electronic microscope in order to compare the protective effects of the two methods.Result showed that there was no significant difference of cTnI concentration between the two groups preoperatively (P>0.05),whereas cTnI concentrations were significantly lower in MCWC than that in ICBC at each points 6 hours after aortic declamping (P<0.01).The myofibrils and mitochondria were damaged more severely in ICBC than that in MCWC.It is concluded that myocardial protective effect under micro dose continuous warm blood cardioplegia perfusion is better than that under intermittent cold blood cardioplegia perfusion.

关 键 词：心脏手术 温血 冷血 心停搏液 心肌肌钙蛋白Ⅰ 超微结构 心肌保护 

分 类 号：R654.2[医药卫生—外科学]