温血心停跳液续灌与冷晶体间灌临床研究

目的 探讨温血心停跳液和冷晶体心停跳液对心肌的保护作用。方法 选择主动脉阻断时间大于60min的心脏手术20例。分别应用温血心停跳液持续灌注（Warmblood Continuous cardioplegia WBCC）（10例）和冷晶体心停跳液间断灌注（Coldcrystalloid intermittent cardioplegia CCIC）（IC例）的结果进行分析。，记录术前、术后6、12、24、48、72h血浆CPK、CK—MB、LDH、LDH．变化。结果两组在心脏直视手术中心脏停跳良好。围术期血液动力学指标、平均动脉压、中心静脉压、心率无明显差异。WBCC的血浆CPK、CK-MB、LDH、LDH1的水平均明显低于CCIC组（P〈0．05）。酶的释出量大为减少，并于72h内降至正常。恢复比CCIC组早。结论 WBCC能保护心脏停跳过程中有氧代谢的进行，减轻再灌注损伤，心肌酶释放减少。WBCC心肌保护效果优于CCIC。

Clinical Application of Continous Warm Blood and Intermittent Cold Crystolliod Cardioplegia Perfusion

Objective To investigate the effects of continous warm blood and intermittent cold crystolloid cardioplegia perfusion on open heart surgery. Methods Randomized study was performed on 20 cases of heart disease, whose cross-clamping time were all more then 60 minutes were seleted. 10 cases received warm blood continous cardioplegia (WBCC) and 10 cases received cold crystalloid intermittent cardioplegia (CCIC). Results Both groups had good heart arrest during operation. There were no difference in mean arterial pressure, heart rate, central venous pressure in the two group. However, plasma levels of CPK, CK-MB, LDH, LDH_1 were significantly lower in WBCC group than those in CCIC group (P<0.05).The enzyme release decreased greatly,and decreased to normal level at 72h,and recover earlier than that of CCIC group.Conclusion WBCC can maintain metabolic balance of myocardium, avoid cardiac reperfusion injury and increase myocardial high energy phosphates contents during ischemia and can provide a better result in myocardial protection,which is better than that of CCIC.