中低温诱导室颤性停搏对心内直视手术心肌保护效果的临床研究

目的探讨中低温室颤性停搏对心内直视手术的心肌保护效果。方法选择行心脏瓣膜置换手术患者60例,ASA分级Ⅱ~Ⅳ级,随机分为中低温室颤性停搏组(A组)和浅低温不停跳组(B组)各30例。各组分别于麻醉后体外循环前、体外循环后60 min、120 min和停机时、手术后6 h、手术后24 h抽取动脉血检测肌酸磷酸肌酶(CK)、心肌型肌酸磷酸肌酶同工酶(CKMB)、乳酸脱氢酶(LDH)、乳酸(Lac)、心肌肌钙蛋白T(cTnT)指标,并取左室心肌标本作扫描电镜观察。结果在麻醉后体外循环前、体外循环后60 min、120 min和停机时、手术后6 h、24 h各时点A组和B组的CK、CKMB、LDH、Lac、cTnT指标水平差异无显著性;心肌电镜扫描发现两组差异无显著性,仅在体外循环120 min后心肌细胞轻度受损。结论中低温诱导室颤性停搏对心内直视手术的心肌保护效果是一种安全有效的心肌保护方法 。

The myocardial protection effect by moderate hypothermic ventricular fibrillation arrest in open-heart surgery

OBJECTIVE To investigate the myocardial protection effect by moderate hypothermic ventricular fibrillation arrest in open-heart surgery.METHODS Sixty patients,with ASA grade from II to IV,were entered the study and randomized to tow groups： moderate hypothermic ventricular fibrillation arrest group（group A,30 cases） and mild hypothermic beating heart group（group B,30 cases）.Arterial blood samples were collected in both groups respectively before CPB,during CPB 60 minutes,120 minutes,and after CPB 24 hours to measure the content of creatine kinase（CK）,MB isoenzyme of creatine kinase（CKMB）,lactate dehydrogenase（LDH）,lactic acid（Lac）,troponin T（cTnT）.At the same time,the samples of left ventricular myocardium were collected to observe in scanning electron microscopy（SEM）.RESULTS The levels of CK,CKMB,LDH,Lac,cTnT were no significant differences in both groups before CPB,during CPB 60 minutes,120 minutes,and after CPB 24 hours.Myocardial cells damaged mildly only after CPB 120 minutes in the observation in SEM.CONCLUSION It＇s a safe and effective method for myocardial protection by moderate hypothermic ventricular fibrillation.