冠状静脉窦逆行灌注压力对心脏双瓣置换术心肌的保护作用

目的探讨冠状静脉窦逆行灌注压力对心脏双瓣置换术患者的心肌保护作用。方法60例心脏双瓣置换术患者随机均分为两组,均先行冠状动脉顺行灌注,再后续逆行灌注的方式行心肌保护。A组逆行灌注压力为30mm Hg,B组逆行灌注压力为40mm Hg;比较两组心肌保护的效果。结果与A组比较,B组术后24-h多巴胺用量和机械通气时间明显减少(P<0.05),术后血清肌酸激酶同功酶(CK-MB)、乳酸脱氢酶(LDH)和肌钙蛋白-I(cTn-I)明显减低(P<0.05),主动脉开放后心脏自动复跳率高。结论在合理的冠状静脉窦逆行灌注压力范围内,40mm Hg的逆行灌注压力对心脏双瓣置换患者的心肌保护效应优于30mm Hg。

Effect of retrograde perfusion pressure through coronary sinus on myocardial protection in patients undergoing cardiac valve replacements

Objective To investigate the effects of retrograde perfusion pressures through coronary sinus on myocardial protection in the patients undergoing cardiac valve replacements.MethodsSixty patients undergoing double-valve replacement were equally divided into 2 groups.Group A was given antegrade coronary sinus perfusion,which was followed by retrograde coronary sinus perfusion at 30 mm Hg.Group B was given antegrade coronary sinus perfusion,which was followed by retrograde coronary sinus perfusion at 40 mm Hg.Efficacy of myocardial protection was compared.Results Compaed to group A,the patients in group B had higher heart rebeating rate after opening the aorta,less dopamine usage in 24 h and shorter mechanical ventilation time after operation(P<0.05).Serum levels of CK-MB,cTn-I and LDH after surgery were obviously lower in group B than those in group A.Conclusion After antegrade coronary sinus perfusion for myoplegia,a retrograde perfusion pressure of 40 mm Hg is better than that of 30 mm Hg in myocardial protection in patients undergoing cardiopulmonary bypass.