自体冷血停搏液对婴幼儿心肌保护作用

目的探讨自体冷血停搏液对婴幼儿先天性心脏病（先心病）体外循环中心肌保护作用。方法婴幼儿非紫绀型先心病30例。随机分为自体冷血（A组）、冷血（B组）和晶体（C组）停搏液组，每组10例。分别于术前、术毕、术后24h、48h经桡动脉抽血检测心肌肌钙蛋白I（cTnI）及磷酸肌酸激酶同功酶（CKMB），术中记录复跳时间及复跳率，术后监测心脏指数（CI），正性肌力药物依赖情况。结果同组手术前后比较，cTnI术毕明显升高（P〈0．001）；CKMB术后24h达到高峰（P〈0．05或P〈0．01）。A组与B组、C组比较：复跳时间、正性肌力药物依赖性、cTnI和CKMB均有显著性差异（P〈0．05或P〈0．01）；CIA组优于B和C组。B组与C组比较：复跳时间、正性肌力药物依赖性和cTnI有显著性差异（P〈0．05），CIB组优于C组。结论自体冷血停搏液对婴幼儿心内直视手术心肌保护优于冷血和晶体停搏液，对未成熟心肌具有良好的保护作用。

The Myocardial Protection of Self-Blood Cardioplegia in Infants during Cardiac Operation

OBJECTIVE To evaluate the myocardial protective effect of self - blood cardioplegia in infants with congenital heart disease in cardiac operation. METHODS 30 cases of infants with congenital heart disease were randomly divided into self - blood （ group A, n = 10）, blood （ group B, n = 10） and crystalloid（ group C, n = 10） cardioplegic solution groups. Artery radial blood sampled was took to measure cTnI and CKMB pre - operation, 24 and 48 hours after op- eration. The time and the ratio of myocardial resuscitation were recorded during operation, the cardiac index （CI） and the dependence degrees of positive inotropic were monitored after operation. RESULTS Compared with pre - operation, eTnI increased immediately （ P 〈 0. 001 ） , and CKMB reached the peak value 24 hours after operation. The difference of eTnI , CKMB , the time of myocardial resuscitation and the dependence degrees of positive inotropic after operation between group A and B or between group A and C were significant（P 〈0.01 ,P 〈0.05）. Comparing between group B and C, there were also significant difference at cTnI, the time of myocardial resuscitation and the dependence degrees of positive inotropic after operation. Cardiac index CI） in group A was higher than group B and C. CONCLUSION Comparing with crystalloid and blood cardioplegic solution, self - blood cardioplegic solution is a good cardioprotection for infants in cardiopulmonary bypass and could provide satisfactory protection for the immature myocardium.