自体冷血停搏液在心脏瓣膜置换术中对心肌保护作用的研究

目的探讨自体冷血停搏液在心脏瓣膜置换术中对心肌的保护作用。方法将心脏瓣膜病患者40例,随机分为自体冷血停搏液组(A组)和4∶1冷含血停搏液组(B组),每组20例。分别于术前、术后6 h、24 h及48 h经桡动脉取血3 ml,采用酶联免疫吸附实验(ELISA)检测心肌肌钙蛋白I(cTnI)、磷酸肌酸激酶同功酶(CK-MB)及心肌型脂肪酸结合蛋白(H-FABP)含量。结果两组患者术后cTnI、CK-MB和H-FABP明显升高,均于术后6 h达高峰,与术前水平比较,显著升高(P<0.01),随后逐渐下降,术后48 h基本接近正常水平(P>0.05)。术后6 h,B组患者三者水平明显高于A组(P<0.05),其余各时点比较,差别无统计学意义(P>0.05)。A组患者心脏自动复跳率明显高于B组(P<0.05),而多巴胺应用时间及呼吸机辅助时间明显少于B组(P<0.05)。室性心率失常发生率、死亡率及低心排发生率两组间差别无统计学意义(P>0.05)。结论自体冷血停搏液能显著降低血浆cTnI、CK-MB及H-FABP水平,能明显提高心脏自动复跳率、减少多巴胺应用及呼吸机辅助时间。自体冷血停搏液在心脏瓣膜置换术中对心肌保护效果优于4∶1冷含血停搏液,对心脏停搏下心内直视换瓣术心肌保护有重要意义。

Myocardial protection of Autologous Cold Blood Cardioplegia in Heart Valve Replacement Surgery

Objective To investigate the myocardial protection of autologous cold blood cardioplegia in heart valve replacement surgery.Methods Forty valvular heart disease patients were randomly divided into autologous cold blood cardioplegia group(group A,20 cases) and the 4∶1 cold blood cardioplegia group(group B,20 cases).3 ml blood were obtained before operation and 6 h,24 h,48 h after the operation via the radial artery.The blood level of cTnI,CK-MB and H-FABP were analyzed by using ELISA.Results The level of cTnI,CK-MB and H-FABP increased significantly and achieved peak at 6 h after the operation(P<0.01),then decreased gradually,descended to the normal level after 48 h.There was significant difference between group A and group B(P<0.05) in the blood lead of cTnI,CK-MB and H-FABP 6 h after the operation.Auto-recovery heart rate of group A was significantly higher than group B(P<0.05),but dopamine application time and ventilation time was less than group B(P<0.05).Conclusion The autologous cold blood cardioplegia can significantly decrease the levels of cTnI,cCK-MB and H-FABP,improve the rate of cardiac auto-resuscitation,reduce dopamine application time and ventilation time.The autologous cold blood cardioplegia was superior to 4∶1 cold blood cardioplegia in the myocardial protective of heart valve replacement surgery.