温、冷血停搏液间断灌注在瓣膜置换术中的心肌保护作用

目的比较体外循环下温血停搏液间断灌注与冷血停搏液间断灌注在瓣膜置换术中的心肌保护作用.方法36例心脏瓣膜置换术患者被随机分为温血间断灌注组(n=18)和冷血间断灌注组(n=18),分别于体外循环前,主动脉开放后30分钟、6小时、24小时采集动脉血,测血清心肌肌钙蛋白Ⅰ(cTnI)浓度.二尖瓣置换患者在主动脉开放时从冠状静脉窦抽取静脉血,检测乳酸浓度.部分患者于主动脉阻断前,开放后30分钟分别取右心房组织,透射电镜观察心肌超微结构.结果瓣膜置换术中温血停搏液间断灌注的心肌保护作用与冷血停搏液间断灌注近似,具有临床应用价值.两组各时间点血清cTnI浓度组间差异无显著性,温血间断灌注组冠状静脉窦血乳酸浓度高于冷血间断灌注组(P＜0.05),两组心肌超微结构变化近似.结论瓣膜置换术中温血停搏液间断灌注的心肌保护作用与冷血停搏液间断灌注近似,具有临床应用价值.

Difference in myocardial protection provided by intermittent warm blood cardiaplegia and intermittent cold blood cardiaplegia during cardiac valve replacement

Objective: To examine the difference in myocardial protection provided by intermittent warm bloodcardiaplegia and intermittent cold blood cardiaplegia during cardiac valve replacement. Methods: A total of 36 patientsundergoing valve replacement were randomly allocated into two groups; (1) intermittent warm blood cardiaplegia (n=18) and (2) intermittent cold blood cardiaplegia (n=18). Arterial blood samples were taken before CPB, 30min,6h and 24h after removal of the clamp for determination of cTnl. Coronary sinus blood samples from patientsundergoing mitral valve replacement were collected and analyzed for lactate level right after removal of theclamp. Myocardium of right atrium from some cases was obtained before and 30 min after removal of the clamp forultrastructural assessment. Results: The lactate level was significantly high in group 1. There was no significantdifference in serum cTnI concentration and mitochondria score between the two groups. Conclusion: During cardiacvalve replacement intermittent warm blood cardiaplegia has a similar effect to intermittent cold blood cardiaplegia onmyocardial protection and can be safely used.