微创不停跳心内直视手术在先天性心脏病中的应用

目的探讨微创不停跳心内直视手术在先天性心脏病手术治疗中的临床应用价值。方法选取房室间隔缺损患者随机分为两组，每组28例。微创不停跳组不阻断升主动脉，在微创常温体外循环（CPB）、心脏跳动下行心内直视手术；停跳组在常规方法下行心内直视手术。分别于术前、术后2、6、12、24、48h取外周静脉血测定心肌肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）的水平，并观察手术时间、CPB时间、术后辅助呼吸时间，多巴胺和硝普钠的用量、住ICU时间，术后住院时间，引流量，用血量等。结果微创不停跳组的手术时间、CPB时间、术后辅助呼吸时间和术后住院时间较停跳组明显缩短，术后进ICU时的多巴胺用量较停跳组少，术后引流量、用血量较停跳组少，差异均有统计学意义（均P〈0．05）。术后2、6、12、24h，停跳组CK-MB和cTnI较微创不停跳组显著升高，差异也均有统计学意义（均P〈0．01）。结论微创不停跳心内直视手术有良好的心肌保护效果，损伤相对较小，是一种安全有效的手术方法，适用于简单先天性心脏病的矫治。

Application of minimally invasive and beating heart surgery for correction of congenital heart diseases

Objective To evaluate the application of minimally invasive and beating heart surgery during cardiopul monary bypass （CPB） for correction of congenital heart diseases. Methods Fifty-six patients were randomly divided into two groups： experimental group （n = 28）, received minimally invasive and beating heart surgery with normal temperature during CPB; control group （n = 28）, received operation on arrested heart with moderate hypothermia （28- 30℃） during CPB. Blood samples were taken from peripheral veins before operation and 2, 6, 12, 24, 48 h after operation1. Blood CK-MB and cTn-I levels were measured; duration of surgery and duration of CPB, duration of postoperative mechanical respiratory assistance and other clinical status were observed. Results In experimental group durations of surgery, CPB, postoperative mechanical respiratory assistance and length of hospital stay were shorter than those in control group; the chest tube drainage and the volume of blood use were significantly less than those in control group （P〈0.05）. At 2, 6, 12, 24 h after operation 1 blood CK-MB and cTn-I levels were significantly higher in control group than those in experiment group （P〈0.01）. Conclusion The results suggest that open heart surgery with beating heart and minimal invasiveness may have less myocardial injury during cardiopulmonary bypass.