瓣膜置换术中温-冷-温灌注方法和单冷含血停搏液灌注的比较

目的比较温-冷-温灌注方法和单冷含血停搏液灌注方法在瓣膜置换手术中的心肌保护效果。方法将84例择期瓣膜置换病人分为2组,一组先用温血停搏液诱导停搏,继用冷血停搏液维持,开放主动脉前用温血停搏液再灌注(组Ⅰ)。一组单用冷(4℃)含血停搏液灌注(组Ⅱ)。2组病人性别、年龄、心功能、主要器官功能和身体状况无统计学差异。分别于麻醉开始前和主动脉开放后即刻、1h、3h、6h、12h、24h、48h、72h抽取外周血测定CK-MB、CTnT含量并记录主动脉阻断时间、体外循环时间、自动复跳率、正性肌力药物使用量和时间、辅助呼吸时间和ICU停留时间。结果2组病人术前CK-MB和CTnT无显著差异,术后均增高。组Ⅰ增高较组Ⅱ增高少,有统计学意义。组Ⅰ自动复跳率较组Ⅱ为高和辅助循环时间、正性肌力药物使用量和时间等较组Ⅱ为少,有统计学意义。结论温-冷-温灌注方法有较好的心肌保护效果。

Comparison of solution between warm - cold - warm and cold blood cardioplegia

Objective To compare the myocardial protective effect between warm -cold-warm method and cold blood car-dioplegia solution in the operation of valve replacement. Methods 84 patients were divided in 2 groups. One group stopped beating by the soluation of warm blood cardioplegia first, and then kept the state by the solution of cold blood cardioplegia and perfused the heart again before opning aorta by the soluation of warm blood cardioplegia (groupl). The other group only used the solution of cold blood cardioplegia (group 2). There were no significant differences in sex, age, heart function, major organ function and the state of body before operation. Blood samples were taken for determine the serum concentration of creatine kinas MB, isoenzume and troponin (CTnT)peri - operatively. And record cardiopulmonary bypass time, cross -clamping time and the rate of heart reheating. Ventilation time, intensive care unit stay time. Results There were no significant deferences in CK - Mb and CTnT between group 1 and group 2 before operation. CK - MB and CTnT became higher post operation in these two groups and significant higher in group2. In group 1 the rate of heart reheating was higher, the time of assisted cilrculatiomis, the time of intensive care unit was shorter/than the group2. There was statistical deference. Conclusion the technique of perfusion of warm - cold - warm has better effect of myocardial protection.