30℃氧合血间断灌注与间断冷晶体灌注对心肌保护的临床观察

目的　为了探索临床上更为安全有效的心肌保护方法。方法　应用 3 0℃氧合温血间断灌注与传统冷停搏液灌注心肌保护法进行心内直视手术各 40例 ,分别对术后心脏复苏情况、心肌酶谱变化、术后心律失常发生例数及术后低心排出量 ,并参照心肌超微结构的变化进行对照分析研究。结果　 3 0℃氧合血间断灌注组与间断冷晶体组心脏复跳率分别为 90 %和 3 5 % (P <0 .0 1)。术后低心排综合征及心律失常发生例数及心肌酶谱变化 ,冷停组均较 3 0℃氧合血组多或明显 ,心肌超微结构的变化示心肌内线粒体损伤以冷停组为重。结论　 3 0℃氧合血间断灌注在心肌保护方面较冷晶体灌注法具有明显的优越性 ,更为安全可靠。

Clinical Observation on Effect of Intermittent Perfusion with 30℃ Oxygenated Blood and Cold Crystalloid in Myocardial Protection

Objective To explore a safer and more effective clinical method of myocardial protection.Method The open heart surgery was performed in 80 patients who were randomly divided into two groups,30℃ oxygenated blood intermittent perfusion(n=40) and cold crystalloid perfusion(n=40) for myocardial protection.With reference to ultrastructual changes of myocardium,the resuscitation rates of the heart,changes of cardiac enzyme(CK MB) and the incidence of arrhythmia and low cardiac output syndrome after operation were analyzed.Results Spontaneous resuscitation rate of heart was 90% and 35% respectively in 30℃ oxygenated blood group and cold crystalloid groups.The incidence of postoperative low cardiac output syndrome and arrhythmia and changes of cardiac enzyme in 30℃ oxygenated blood group were less than those in cold crystalloid group.Ultrastructual changes of myocardium showed the damages were more serious in cold crystalloid group than in oxygenated blood group.Conclusions Intermittent perfusion with 30℃ oxygenated blood is superior to that with crystalloid for myocardial protection.It is a safer and better method for myocardial protection.