心脏手术中持续冷血灌注对心肌的保护作用

目的探讨15℃冷血持续灌注保护心肌的效果和机制并总结临床应用经验。方法30例患者随机分为两组在全麻低温体外循环下手术:对照组(晶体停搏液间断灌注组)14例,冷血组(15℃冷血持续灌注组)16例;主动脉阻断前和开放后10min,取右室心肌测定ATP和CP含量,并电镜观察两组患者的心肌超微结构变化。结果冷血组无低心排发生,对照组发生2例,冷血组ATP和CP保存较对照组明显增多,两组比较有显著性差异(P<0.05)。对照组心肌结构呈现缺血、缺氧改变,冷血组改变不明显。结论在心脏手术中持续冷血灌注保护心肌,有利于心肌ATP和CP保存,并可避免过度血液稀释和高钾血症,有益于危重患者。

Protective effects of continuous cold blood cardioplegia perfusion on myocardium

Objective To evaluate the effects and mechanism of continuous cold blood cardioplegia on myocardium and to review its clinic use experiences.Methods Thirty patients with congenital heart disease were randomly divided into two groups:crystalloid cardioplegia perfusion in14patients as controlled group,continuous cold blood cardioplegia used in16patients as treated group.All patients were subjected to operation under CPB with mild or deep hypothermia.Myocaridal sample of right ventricle for measurement of ATP and CP and for electronic microscopy were obtained before aorta occlusion and10minutes after aorta cross clamp releasing.Results Low cardiac output syndrome was not found in treated group but occurred in two patients in controlled group.The contents of ATP and CP in treated group were higher than that in controlled group(P<005).Ischemic and hypoxic changes were obviously observed in controlled group.No distinct changes were found in treated group.Conclusion The effects of continuous cold blood cardioplegia on myocardium is to be advantageous for the preservation of ATP and CP,can keep the integrity of myocardial ultrastructure,so that is helpful to the patient