心脏不停跳心脏瓣膜置换术的临床研究

目的:比较浅低温体外循环(CPB)心脏不停跳与中度低温CPB心脏停跳心肌保护的效果。方法:60例风湿性心脏病(RDH)患者随机分为实验组和对照组。实验组为浅低温CPB心脏不停跳组,对照组为中度低温CPB心脏停跳组,每组30例。测定心肌磷酸肌酸激酶(CK)及其同工酶(CK鄄MB)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转换酶(AST)。于心内操作前、后观察超微结构变化。结果:实验组CPB时间、心肌超微结构与对照组差异有统计学意义(P<0.01),术后各时段心肌酶升高程度明显低于对照组。结论:浅低温CPB心脏不停跳优于中度低温CPB心脏停跳心肌保护的效果。

Clinical study of valve replacement on beating heart

Objective: To study the myocardial protection effect of beating heart during valve replacement procedures of mild hypothermic cardiopulmonary bypass(CPB). Methods: Sixty patients with rheumatic heart diseases were randomly divided into two groups: 30 in the study group who underwent valve replacement on beating heart under mild hypothermic CPB and 30 in the control group who experienced the similar procedures on arrested heart under moderate hypothermic CPB. Myocardial enzymes including CK, CK-MB, LDH and AST were determined and the myocardial ultrastructure was observed before and after operation. Results: Compared with the control group, the study group had shorter CPB duration, less enzyme release and milder alterations in myocardial ultrastructure postoperatively. Conclusion: Mild hypothermic CPB on beating heart provides better myocardial protection than moderate hypothermic CPB on arrested heart