浅低温不停跳心内直视手术的临床分析

目的　通过临床随机对照试验,探讨浅低温不停跳心内直视手术的心肌保护作用及其优缺点。方法　40例房间隔缺损或室间隔缺损患者随机分为两组,每组 20例。心跳组不阻断升主动脉,在浅低温体外循环、心脏跳动下完成心内直视手术;停跳组在常规方法下行心内直视手术。分别于术前、停机即刻、术后 6h、12h、24h、48h分别取外周静脉血测定心肌酶(CK)、肌钙蛋白-I(cTnI)的血浆浓度并观察手术时间、体外循环时间、多巴胺和硝普钠的用量及患者在ICU时间等。结果　停机即刻、术后 6h、12h,停跳组的CK含量较心跳组显著升高 (P<0.01);停跳组cTnI的量在停机即刻至 48h均高于心跳组;不停跳组平均体外循环时间(52. 4±17. 5)min,明显低于停跳组(84. 8±16. 6)min(P 0. 01)。心跳组术后血流动力学稳定。结论　不停跳心内直视手术是一种有效的心肌保护方法,缩短了手术时间,但对复杂心内畸形的操纵需进一步探讨。

A Clinical Trial of Open-Heart Surgery on Beating Heart

OBJECTIVE To evaluate protective effect of mild hypothermic cardiopulmonary bypass(CPB) on beating-heart. METHODS Forty patients with atrial septal defect or ventricular septal defect were randomly divided into two groups. The patients in control group were operated under the mild hypothermal extracorporeal circulation with aortic cross-clamping and cardial arrest while experiment group was operated on with cannulation of superior and inferior venae caval under light hypothermal extracorporeal circulation on beating heart.Blood samples were taken from peripheral veins for assessing the level of troponin-I (cTnI), creatine kinase (CK). And other clinical status observed. RESULTS In control group the level of cTnI, CK significantly increased during CPB. After reperfusion cTnI, CK were significantly higher in control group than those in experiment group,Pump was stopped immediately at the end of operation. Only a few patients needed low dose of dopamine to suppport circulation and no air embolism occured.CONCLUSION Open-heart surgery with beating-heart and mild hypothermic cardiopulmonary bypass(CPB) could ameliorate myocardial injury in experiment group. Further study is necessary for it's application in complex cases.