腺苷联合高钾冷血停搏液对成人心脏手术心肌的 保护作用

摘要： 目的 观察在成人心脏手术中腺苷联合冷血停搏液的心肌保护作用。方法 选取行冠状动脉搭桥手术 的患者 100 例、 二尖瓣置换术患者 30 例， 每个手术组中又随机分为 2 组： 腺苷组用 6 mg 腺苷注射液在阻断升主动脉 后即刻经升主动脉根部一次性快速注射， 随即灌注高钾冷氧合血心肌停搏液； 对照组只单纯灌注高钾冷氧合血心肌 停搏液。2 组患者均每 30 min 复灌半量不含腺苷的相同成分的冷血停搏液， 比较 2 组的相关临床指标和心肌酶学 测定结果。结果 对于行冠脉搭桥手术的患者， 腺苷组的停搏诱导时间、 ICU 停留时间、 术后辅助通气时间及多巴胺 用量均少于对照组（P < 0.05）， 2 组灌注停搏液的次数、 灌注总量、 主动脉阻断时间、 转机时间、 自动复跳率无明显差 异 （P＞0.05）。对于行单纯二尖瓣置换术的患者， 腺苷组的停搏诱导时间、 多巴胺用量少于对照组 （P < 0.05）， 2 组灌 注停搏液的次数、 灌注总量、 主动脉阻断时间、 转机时间、 ICU 停留时间、 术后辅助通气时间及自动复跳率差异无统计 学意义（P＞0.05）。行 2 种手术的患者， 均是主动脉阻断后 4 h， 腺苷组的肌酸激酶同工酶（CK-MB）低于对照组， 主 动脉阻断后 4 h 及 24 h， 对照组的心肌肌钙蛋白 （ I cTnI） 均明显高于腺苷组 （均 P < 0.05）。结论 心脏血运阻断后即 刻经由主动脉根部灌注稀释腺苷液及高钾冷氧合血心肌停搏液， 能够使心脏快速停跳、 减少心肌酶的释放， 减少术 后血管活性药的用量， 缩短术后辅助通气时间以及 ICU 停留时间

The myocardium protection of the joint application of adenosine and cold-blood cardioplegia containing potassium in coronary artery bypass grafting

Abstract:Objective To observe the myocardium protection of the joint application of adenosine and cold- blood cardioplegia containing potassium in coronary artery bypass grafting (CABG) under cardiopulmonary bypass. MethodsOne hundred patients underwent coronary artery bypass grafting and thirty patients underwent replacement of mitral valve were included in this study, and patients were randomized to two groups. Adenosine group (group I):6 mg adenosine was diluted with physiological saline and injected from the root of the ascending aorta after blocking it. The aorta was then perfused with high- potassium cold- blood cardioplegia. Control group (group II):the aorta was just perfused with high potassium cold- blood cardioplegia. Adenosine was only added in first perfusion in adenosine group. Both groups were reperfused half-amount of cold-blood cardioplegia containing potassium every 30 minutes. Relevant clinical indexes and myocardial enzymological determination were compared between two groups. Results For patients who underwent CABG, the cardiac arrest induced time， ICU dwell and assisted ventilation time after surgery and dopamine usage were all less in adenosine group than those of control group (P < 0.05). There were no significant differences in the total number of cardioplegia of perfusion fluid, the total amount of perfusion, clamping aorta and assisting circulation times and automatic rebeating between two groups (P > 0.05). For patients who underwent MVR, the cardiac arrest induced time and dopamine usage were all less in adenosine group than those of control group (P < 0.05). There were no significant differences in times and total number of cardioplegia of perfusion fluid, clamping aorta and assisting circulation times, ICU dwell and assisted ventilation time after surgery automatic rebeating between two groups (P > 0.05). For both operations, 4 hours after clamping aorta, creatine kinase isoenzyme (CK-MB) was less in adenosine group than that of control group (P < 0.01 or P < 0.05), and 4 hours and 24 hours after bypass, cardiac troponin I (cTnI) was significantly higher in control group than that of adenosine group (P < 0.05). Conclusion After aorta is clamped, immediate injection of adenosine diluent and cold- blood cardioplegia containing potassium from the root of the ascending aorta can lead to quick heart arrest, reduce the release of myocardial enzymes and dosage of vasoactive agents, and shorten ICU dwell and assisted ventilation time