晶体停搏液与氧合血停搏液结合应用于重症心脏病手术心肌保护的临床观察

目的回顾分析66例成人重症心脏病手术病人采用晶体停搏液与氧合血停搏液联合应用心肌保护的临床效果。方法对66例采用晶体停搏液与氧合血停搏液联合心肌灌注方法的成人重症心脏病手术病人的体外循环的资料,包括体外循环时间,主动脉阻断时间,自动复跳率,心脏停搏时间,主动脉开放后心肌复跳时间等指标进行回顾性分析。结果全组病例体外循环时间为63～268 min,平均(131.5±47.8)min,主动脉阻断时间为38～146 min,平均(88.4±45.1)min,自动复跳64例(97%),心脏停搏时间15～220 min,平均(87.9±63.1)min。主动脉开放后心肌复跳时间5～700 s,平均(181±159)s。电击复跳2例(3%)。转中尿量300～800 ml,平均(422±110)ml。转中常规超滤及零平衡超滤,超滤液1 200～2 500 ml,平均(1 600±420)ml。术中出血量300～1550 ml,平均(630±240)ml,术中输血量600～1 200 ml,平均(840±230)ml。术后死亡1例(1.5%),死于低心排出量综合征。其余患者顺利出院。结论采用晶体停搏液与氧合血停搏液联合应用于重症心脏病手术心肌保护方法临床效果良好。

Clinical observation on the myocardial protective effect of a combination method of crystalloid and blood cardioplegic solution during open heart surgery

Objective To evaluate the myocardial protective effect of a combination method of crystalloid and blood cardioplegic solution during open heart surgery under cardiopulmonary bypass.Methods The data of 66 patients undergoing elective cardiac valve replacement under cardiopulmonary bypass were retrospectively analyzed,including cardiopulmonary bypass time,aortic cross-clamping time,spontaneous resuscitation rate,cardiac arrest time,heart rebeating time after aortic declamp and so on.Results In all of patients,cardiopulmonary bypass time was 63～268min,average time was(131.5±47.8)min;aortic cross-clamping time was 38～146min,average time was(88.4±45.1)min;there were 64 cases with spontaneous resuscitation(97%);cardiac arrest time was 15～220min,average time was(87.9±63.1)min;heart rebeating time after aortic declamp was 5～700s,average time was(181±159)s;there were 2 cases with electric shocks resuscitation(3%);urine volume during cardiopulmonary bypass was 300～800ml,average was(422±110)ml;ultrafiltrate content of conventional ultrafiltration and zero balancing ultrafiltration during cardiopulmonary bypass was(1 200～2 500)ml,average content was(1 600±420)ml;intraoperative bleeding was(300～1 550)ml,average was(630±240)ml;intraoperative blood transfusions was(600～1 200)ml,average was(840±230)ml.Patients discharged from hospital except 1 case died(1.5%) caused by syndrome de volume cardiaque bas.Conclusion The combination method of crystalloid and blood cardioplegic solution to perfuse the heart during open heart surgery under cardiopulmonary bypass is an effective method of myocardial protect.