冷温血停搏液联合灌注在儿童先天性心脏病中的应用研究

目的 评价冷温血停搏液联合灌注在儿童先天性心脏病(CHD)手术中对心肌的保护作用,探讨更有效的心肌保护方法。方法 将24例儿童先天性心脏病病人随机分为两组:温血组(A组,n=12),采用温血诱导心脏停搏、冷血维持与终末温血灌注进行心肌保护;冷血组(B组,n=12),采用冷氧合血停搏液进行心肌保护。两组间主动脉阻断时间无明显差异;体外循环前(T1)、主动脉开放1h(T2)、主动脉开放6h(T3)、主动脉开放12h(T4)、主动脉开放24h(T5)分别抽血测定乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK—MB)、心肌肌钙蛋白T(cTnT)。结果 体外循环前两组间含量无差异。主动脉开放后LDH、CK—MB、cTnT含量较体外循环前明显升高(P<0.01),T4、T5时点B组,LDH、CK—MB含量较A组明显升高(P<0.05),T3～T5时点B组cTnT含量较A组明显升高(P<0.05)。结论 冷温血停搏液联合灌注对儿童先天性心脏病病人的心肌保护作用优于冷血心脏停搏液。

Clinical Research of United-Infusion of Cold and Warm Blood Cardioplegia Solution on Congenital Heart Disease of Child

Objective To investigate the myocardial protective effect of united-infusion of cold and warm blood cardio-plegia solution on correction of congenital heart disease in children to find the effective method of myocardial preservation. Methods Twenty-four children with congenital heart disease were randomly divided into two groups;Group of warm blood cardioplegia solution (group A,n= 12) ,infusion with cold blood cardioplegia solution .combined with warm blood cardioplegic solution immediately after aortic clamping and just before aortic unclamping; Group of cold blood cardioplegia solution (group B,n = 12) ,infusion with cold blood cardioplegia solution. There were no difference of aortic crossclamp time in two groups. Samples were taken before CPB(Ti),1 hour(T2),6 hour(T3) ,12 hour(T4),and 24 hour(T5)after aortic release for determination of lactat dehydrogenase(LDH),creatine kinase MB(CK-MB)and troponin T(cTnT). Results There were no difference of the content of LDH,CK-MB and cTnT between group A and group B before CPB. After aortic release the content increased significantly than those before CPB(P<0. 01). The content of LDH and CK-MB in group B increased significantly than those in group A at T4 and T5 after aortic release (F<0. 05) ,and the content of cTnT in group B increased significantly than that in group A at T3,T4 and T5(P<0. 05). Conclusion United-infusion of cold and warm blood cardioplegia solution is superior to cold blood cardioplegia solution in children with congenital heart disease.