心脏跳动下修补小儿室间隔缺损的临床研究

目的　探讨在浅低温体外循环心脏跳动下完成小儿室间隔缺损修补术的可行性。方法　 18例小儿室间隔缺损随机分为观察组和对照组 ,观察组在浅低温体外循环心跳下修补室间隔缺损 ,对照组为常规心脏停跳下修补室间缺损。测定心肌同功酶释放和三磷酸腺苷 ,观察左室压力 ,评价术野显露及气栓预防效果等。结果　观察组心肌同功酶释放明显低于对照组 ,三磷酸腺苷含量明显高于对照组 ,心肌超微结构基本正常 ,术中左室压力低于主动脉压力 ,术后无气栓发生。结论　浅低温体外循环心脏跳动下行小儿室间隔缺损修补术能更好地保护心肌。术野显露技术和防气栓的方法简便可行。

Clinical study of child ventricular septal defect repair under beating heart

Objective To discuss the feasibility of the child ventricular septal defect repair under beating heart at hypothermia.Methods 18 children with ventricular septal defect were randomly divided into two groups: observation group which were operated on under beating heart at extracorporeal circulation and the control group under beating heart.The myocardial isoenzyme releasing activity and ATP content were assayed .The left ventricular pressure was observed and the operative field exposure and the results of prevention of gas embolus were evaluated.Results The myocardial ATP content in observation group was higher than that in the control group,while isoenzyme releasing activity was much lower than that in the control group(P<0.05).The super-micro structure of myocardium was basically normal.The left ventricular pressure was lower than that of aortic pressure during operation.No postoperative gas embolus occurred.Conclusion Ventricular septal defect repair under beating heart and slight hypothermia may better protect myocardium during which the operative field exposure and prevention of gas embolus is simple to manipulate.