维生素C、甘露醇温血灌注对换瓣术中心肌缺血再灌注损伤的保护作用

目的 :探讨应用含维生素C、甘露醇温血灌注液的终末再灌注在瓣膜置换术中心肌保护的效果。方法 :将6 5例风心病瓣膜置换术患者随机分为实验组 (33例 )和对照组 (32例 ) ,均采用冷血间断灌注心肌保护 ,实验组在开放主动脉前给与含维生素C、甘露醇的温血灌注液行终末再灌注。比较两组患者体外循环术后心肌保护的效果。结果 :在自动复跳率、低心排发生率、血清肌酸激酶、乳酸脱氢酶及丙二醛等指标实验组明显优于对照组 (P <0 .0 5 ) ,在术后呼吸机支持时间、死亡率及正性肌力药物使用率等方面两组无显著性差异 (P >0 .0 5 )。结论 :含维生素C、甘露醇温血灌注液的终末灌注能明显减轻心肌缺血再灌注损伤 ,有利于术后早期心功能的恢复。

PROTECTIVE EFFECTS OF VITAMINE C ,MANNITOL,HOMOTHEMNIC PERFUSION ON MYOCARDIAL ISCHEMIA AND REPERFUSION INJURY IN CARDIAC VALVE REPLACEMENT

Objective:This study was designed to assess the protective effects of Vitamine C,Mannitol,Homothemic perfusion at the last perfusion. Methods:The study consisted of two groups of patients. 6 5 patients have their cardiac valve replacement. Group A (n=33 ),received cold blood cardiac perfusate impermanently with Vitamine C,Mannitol and Homothemic perfusion at the last perfusion. Group B(n= 3 2 )received same cold bood cardiac perfusate impermanently only. We analyzed following extracorporeal circulation,and the protecive effects on myocardial reperfusion injury.Results:Heart self-beat rate, low cardiac output syndrome occurrence rate,Creating kinase level, Lactate dehydrogenase level and malondialdehyde level in group A was significantly better ( P <0.05).After operation,the hours of mechanical ventilation,death rate and inotropic medicine dosage in the two groups had no obvious difference( P >0.05).Conclusions:Vitamine C,Mannitol,Homothemic perfusion at the last perfusion may obviously reduce myocardial ischemic and reperfusion injuries. And it accelerats the recovery of cardiac function.