间歇微温血心脏停搏液改善心肌保护

目的　研究微温血心脏停搏液的心肌保护效果。方法　前瞻性收集 15 33例体外循环病人的临床资料进行分析。微温血组 :5 82例病人于 1998年 7月至 2 0 0 0年 7月用间歇微温血心脏停搏液 (2 8℃ ) ;冷血组 :95 1例病人于 1994年 9月至 1997年 11月用冷血心脏停搏液 (4℃ )。用χ2 检验、两样本均数 t检验和多变量 L o-gistic回归分析对 2 7项病人相关变量和 18项预后相关变量进行分析。对高危和常规冠状动脉旁路移植的病人进行进一步的分析。结果　两组临床资料相似 ,但微温血组病人症状重、有更多的再次手术和复合手术、更多的手术在急性心肌梗死 7d以内。微温血组术后需要主动脉内球囊反搏率 (2 .2 % vs4 .4 % ,P=0 .0 2 4 )和房颤率 (2 0 .6 %vs2 5 .7% ,P=0 .0 2 6 )明显较冷血组少。死亡率、围术期心肌梗死、脑血管事件和血管活性药物应用两组无明显区别。结论　间歇微温血心脏停搏液用于心脏外科在临床上是适当的和安全的

Intermittent tepid blood cardioplegia improves clinical outcome

Objective To investigate the myocardial protective effect of tepid blood cardioplegia.Methods Prospectively collected data on 1 533 patients undergoing cardiopulmonary bypass procedures in a single surgeon′s practice were analysed.The use of intermittent antegrade cold (4℃) blood cardioplegia in a cohort of 951 consecutive patients from Sep 1994 to Nov 1997 was compared with that of intermittent antegrade tepid (28℃) blood cardioplegia in 582 consecutive patients from Jul 1998 to Jul 2000.Twenty seven patient related and 18 outcome variables were analysed by the χ 2,independent T-tests and multivariate analysis.High-risk and elective CABG (coronary artery bypass grafting) only subgroups were analysed separately.Results The two groups were similar,but in the tepid group the symptom class was more severe,there were more redos or combined procedures and more procedures within 7 days of myocardial infarction.Clinical benefits identified in the tepid group included a reduced usage of intra-aortic balloon pumps postoperatively (2.2% vs 4.4%,P=0.024) and a reduced incidence of post-operative atrial fibrillation (20.6% vs 25.7%,P=0.026).There was no signifcant difference between the groups in mortality,peri-operative myocardial infarction,cerebrovascular events and vasoactivator usage.Conclusion Intermittent tepid blood cardioplegia is clinically appropriate and safe to use in patients undergoing cardiac surgery.