心脏双瓣膜及主动脉瓣置换术的综合性心肌保护

本文报告40例双瓣膜或主动脉瓣置换术的综合性心肌保护措施,包括(1)术前用GlK液和巯甲丙脯酸治疗;(2)术中注意低温、灌注压稳定、左室引流、缩短主动脉阻断时间、经主动脉根部和冠状动脉分次灌注心脏冷停跳液和适当延长辅助循环时间;(3)心脏再灌注后和术后早期静脉滴注硝普钠。本组死亡5例,4例与室性心律失常有关。硝普钠可减少术后室性心律失常发生。

The Comprehensive Myocardial Protections during Double or Aortic Valve Replacement

Double or aortic valve replacement was performed on 40 consecutive patients in our hospital between June 1988 and October 1991.There were several measures of myocardial protection worth mentioning in this series they includ: (1) preoperative use of G1K solution and Captopril; (2) during operation attention paid to hypothermia, stableperfusion pressure, vent of left ventricle, shorten the aortic cross-clamping time,cardio plegia delivery through aortic root combined with the coronary arteries and lengthening of assistant circulation and, (3) use of sodium nitroprusside during the reperfusion period of CPB and the early postoperative period. Ventricular arrhythmias were the most frequent cause of death after valve replacement.There were 5 deaths in our series and all but one were related to ventricular arrhythmia.It was noted that a striking reduction in the postoperative arrhythmia in those patients who were given sodium nitroprusside during the payback period of CPB and 1 to 2 days after operation.