不同心肌保护方法对心肌细胞膜流动性影响的临床对比研究

目的 应用心肌细胞膜流动性评价间断冷晶体灌注、持续微温血灌注及微温不停跳直视手术技术的心肌保护效果。方法 将我科30例先心病患者，随机分成持续微温血灌注组(CT组)、微温心不停跳组(OB组)、间断冷晶体灌注组(IC组)，于开放升主动脉前取心肌标本，对照组(C组)取自前三组中随机10例转流前心肌标本。测每组的心肌细胞膜流动性，将测得结果进行统计学方差分析。结果 冷晶体组细胞膜流动性明显低于其他三组(P值均小于0．001)；温血组与不停跳组无差别(P＞0.05)；温血组与对照组无差别(P＞0.05)；不停跳组低于对照组(P＜0.05)。结论 持续微温血灌注组的心肌细胞膜保护效果最为满意，微温不停跳组次之，二者均明显优于冷晶体技术。

The effect of intermittent cold crystalloid、continuous tepid blood cardioplegia and open Heart operation with beating: the clinical comparative study of myocardial membrane fluidity

Objective To study the changes in myocardial membrane fluidity during intermittent crystalloid cardioplegia, continuous tepid blood cardioplegia and open-heart operation with beating for congenital heart disease. Methods The patients undergoing cardiovascular operation in our department were randomly divided into four groups (10 patients in each group). The sample of every patient in group IC perfused with intermittent cold crystalloid cardioplegia (St. Thomas), group CT perfused with tepid blood cardioplegia continuously, and group OB received open heart operation with beating was taken from RA (10-30mg) at the end of the aortic crossclamp period and before crossclamp, the samples of ten patients were take a from RA as the control group (group C). The membrane fluidity of each sample was measured by fluore-science polarization method. Analyses of Variance (SAS) were used to evaluate the difference among each groups. Results The membrane fluidity of group IC was lower than any other groups (each P <0.001). The difference of fluidity between group C and group CT, between group CT and OB are both not significant (each P >0.05). The difference between group C and OB is significant ( P <0.05). Conclusion The continuous tepid blood cardioplegia has the best protective effect on myocardial membrane:both the open-heart operation with beating and tepid blood cardioplegia are superior to intermitted cold crystalloid cardioplegia.