再次心肌灌注法在心脏手术心脏复苏困难时的应用

目的 研究再次心肌灌注法在心内直视手术主动脉开放后心脏复苏困难时的应用.方法 回顾性分析15例在心内直视手术开放升主动脉后发生心脏复苏困难患者的临床资料,采取不阻断或再阻断升主动脉,行控制性灌注温血半钾停搏液,至心肌电活动停止.结果 所有患者心脏成功复跳,并顺利脱离体外循环.其中9例采取不再次阻断升主动脉,仅行再次灌注温血半钾停搏液的方法,使7例自动复跳,2例电击除颤1次后复跳;5例行第2次阻断升主动脉后灌注温血半钾停搏液后3例自动复跳,2例电击除颤1次后复跳;1例行冠状动脉搭桥并主动脉瓣置换术先后共行4次阻断再行灌注后复苏成功.结论 对于心内直视手术开放升主动脉后的心脏复苏困难,采取再次心肌灌注是行之有效的处理方法.

Application of repeated myocardial perfusion on difficult cardiac resuscitation under open heart operation

Objective To investigate the application of repeated myocardial perfusion on difficult cardiac resuscitation after aortic unclamping under open heart operation. Methods Fifteen cases met difficult cardiac resuscitation after release of aortic cross-clamping under open heart operation were analyzed retrospectively. They were perfused with or without repeated aortic clamping, with warm blood cardioplegic solution until electric activity of cardiac muscle stop. Results All cases got cardiac resuscitation and detached from-cardiopulmonary bypass (CPB) successfully,9 cases perfused with warm blood cardioplegic solution without repeated aortic clamping got cardiac resuscitation automatically(7 cases) or after defibrillation for one time (2 cases),5 cases experiencing repeated aortic clamping and perfused with warm blood cardioplegic solution for two times got cardiac resuscitation automatically (3 cases) or after defibrillation for one time (2 cases) and another one experiencing for four times. Conclusion Application of repeated perfusion on difficult cardiac resuscitation after aortic unclamping under open heart operation is effective.