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

为提高心脏手术中心保护的效果，将20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、24、72小时血清心肌肌钙蛋白Ⅰ（cTnI）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cTnI无显著性差异（P＞0．05）；主动脉开放后6、12、24、72小时温血组cTnI均显著低于冷血组，P＜0．01；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。认为温血心脏停搏液微流量连灌的心肌保护效果优于冷血心脏停搏液间断灌注。

Comparison of myocardial protective effects of micro-dose continuous warm blood cardioplegia perfusion and intermittent cold blood cardioplegia perfusion

To improve the myocardial protective effect,20 patients with rheumatic heart valvular disease were randomly divided into two groupsmicro 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.