缺血预适应对体外循环血流动力学影响的临床研究

目的：比较冷停搏液与缺血预适应（IPC）加冷停搏液联合应用对先天性心脏病心内直视手术后血流动力学的影响。方法：先天性心脏病病人20例，随机分为缺血预适应组（IPC，n=10)和对照组（n=10）。IPC组在阻断升主动脉前实施缺血预适应（即3分钟缺血5分钟再灌注），阻断升主动脉，灌注（4℃）St Thomas‘停搏液，心脏完全停跳后开始心内手术；对照组则不进行缺血预适应方案。两组均于并循前、开放升主动脉心脏复跳后300min、60min时经Swan-Ganz漂浮导管测定各项备流动力学指标，并观察心肌功能恢复情况、动脉血气及电解质变化。结果：CPB后IPC组血流动力学指标恢复快（P＜0．05），心肌收缩有力，血压维持良好，需辅用多巴胺等强心药维持血压的病例明显少于对照组（P＜0．05）；两组动脉血气无明显变化（P＜0．05）。结论：缺血预适应加冷停搏液联合应用能促进体外循环心内直视手术后血流动力的恢复。

Effects of ischemic preconditioning on hemodynamic during cardiopulmonary bypass

Objective To evaluate the effects of ischemic preconditioning (IPC) with cold cardioplegia perfusion on hemodynamci during cardiopulmonary hypass (CPB). Methods Twenty congenital heart disease patients were randomly divided into two groups. Control group ( n =10) received intermittent cold crystalloid cardioplegia perfusion. IPC group ( n =10) receive IPC by clamping aorta 3 minutes and then declamping 5 minutes before cold cardioplegia perfusion.Hemodynamic parameters,blood gas and electrolyte were recorded before CPB,30 min and 60min arter declamping aorta by Swan-Ganz catheter.Results In IPC group the recovering of hemodynamic parameters was sooner after CPB ( P <0.05).The blood pressures were excellent maintained and the proportion of using positive inotropic drugs such as dopamine were lower in IPC group.There's no significant change in blood gas analysis before and after CPB.Conclusion The combination of IPC and cold cardioplegia perfusion could improve hemodynamic during CPB.