逆灌浅低温氧合血心脏不停跳和冷血心脏麻痹液对心肌代谢影响的临床研究

目的　对比逆灌浅低温氧合血心脏不停跳与中低温冷血心脏麻痹液对体外循环过程中心肌代谢的影响。方法　观察 18例风湿性心脏病双瓣置换术患者体外循环期间心肌氧摄取率、动脉血及冠脉回流血乳酸、H 浓度及主动脉阻断前后房间隔心肌组织腺苷酸类物质含量、心肌超微结构变化。本组分为心停跳组和心不停跳组。结果　心不停跳组心肌氧摄取率高于心停跳组 (P <0 .0 1) ,动脉血 冠脉回流血乳酸、H 差值低于心停跳组 (P <0 .0 5 ) ;心停跳组主动脉开放前心肌超微结构损伤较心脏不停跳组明显 ,房间隔心肌组织ATP、TAN含量低于主动脉阻断前 (P <0 .0 5 ) ,心不停跳组降低不明显 (P >0 .0 5 )。结论　逆灌浅低温氧合血心脏不停跳法的心肌保护效果优于逆灌中低温冷血心脏麻痹液法

Clinical study of retrograde tepid oxygenated blood while heart beating and cold blood cardioplegia on myocardial metabolism

Objective To evaluate continuous retrograde tepid oxygenated blood via coronary sinus as compared with cold blood cardioplegia on myocardial metabolism.?Methods Eighteen patients subjected to DVR were assigned to beating heart group(n=9) and arrested heart group(n=9). Rate of myocardial oxygen extraction,levels of lactate,hydrogen ion concentration(H ) in arterial blood,blood returned from coronary artery ostia, contents of ATP, ADP,AMP in atrial septum and myocardial ultra structure were observed before,during and after aortic cross clamping.?Results Rate of myocardial oxygen extraction after aortic cross clamping was decreased in both groups,whereas it was more markedly decreased in arrested heart group. Rate of myocardial oxygen extraction of the beating heart group at 10 minutes after removal of aortic cross clamp was higher than that found in the arrested heart group. The (H ) and lactate concentration in the arrested heart group were apparently higher than those in the beating heart group. In the arrested heart group,the contents of ATP, ADP, AMP and TAN in atrial septum decreased significantly before removal of cross clamp than those before aortic cross clamping. Atrial septum ultra structure was damaged more seriously in the arrested heart group before removal of cross clamp than that before aortic cross clamping, however,no patent injury was observed in the beating heart group.?Conclusion Protective effects of continuous tepid oxygenated blood perfusion via coronary sinus on myocardium was superior to cold blood cardioplegia perfusion in patients underwent DVR.