婴儿心脏直视手术中不同压力灌注停搏液心肌保护效果的临床观察

目的　观察婴儿体外循环心脏手术中不同压力灌注停搏液心肌保护的临床效果。方法　选择在体外循环、心脏停搏下行心室间隔缺损修补的婴儿 45例 ,按心肌保护液灌注压力不同随机分三组 :1组 ,P =6 0mmHg ;2组 ,P =45mmHg ;3组 ,P =30mmHg。观察 :①实验室指标术前、主动脉开放 (CCR)后 30min、6h、2 4h心肌酶 (CK MB、LDH)、心肌肌钙蛋白 (cTnI)浓度 ;②临床指标 :灌注诱导停搏时间 ;主动脉开放后复跳时间、自动转窦率 ;术后正性药物使用情况 ;呼吸机辅助时间、ICU(加强护理病房 )停留时间、术后住院时间。结果　①灌注压力与诱导停搏时间、复跳时间呈负相关 ,诱导停搏时间、复跳时间组 (118.7± 5 .5 )s、(2 5 .1± 16 .0 )s小于组 3(2 3.7± 5 .5 )s、(4 3.7± 2 2 .1)s,P<0 .0 5 ;②自动转窦率组 2 (93.3% )高于组 1(86 .7% )、组 3(86 .7% ) ;③ 3组在CCR后各时点CK MB、LDH、cTnI与基础值相比均有明显升高 ,P <0 .0 1;CK MB、cTnI以CCR后 30min最高 ,与其他时点相比P <0 .0 5 ;LDH以CCR后 6h最高 ,与其他时点比较P <0 .0 5。组 1CCR后 6hLDH(6 92 .2 4± 139.9)U/L明显高于组 3(5 6 9.0± 10 8.5 )U/L ,P <0 .0 5 ;④术后多巴胺、多巴酚丁胺的使用量组间各时点无统计学差异 ,停机时组 1虽高于组 3;组

Myocardial protection with different infusion pressure in infants undergoing open heart surgery

Objective To observe the myocardial protective effects of three different pressure of cardioplegia infusion on infants undergoing cardiopulmonary bypass(CPB).Methods A consecutive series of 45 infants with ventricle septum defect (VSD) who underwent CPB repair were randomly divided into three groups according to the myocardial infusion pressure: Group 1, P=60?mmHg; Group 2, P=45?mmHg and Group 3, P=30?mmHg. Serum enzymes' concentration and cardiac troponin I (cTnI) were measured before the operation, and at 0.5, 6, 24 hours after de-clamping. The cardioplegia time and de-clamping time, ventilator-supporting time, ICU staying and hospitalization were recorded. Results 1) the cardioplegia time and asystole time decreased with the increasing of infusion pressure. The cardioplegia time and asystole time decreased in G3 were longer than in G1 (P< 0.05). 2) The spontaneous sinus rhythm conversion rate was higher in G2. 3) The CK-MB, LDH and CTnI level were higher in all groups at de-clamping time than that of the basic levels(P< 0.01). LDH at 6h after de-clamping is higher in G1 than that of G3(P< 0.05). 4) The mechanic ventilation time, ICU staying, dopamine and dobutamine administration were similar among the three groups. One case in G1 and G3 respectively needed adrenaline support while none in G2. Conclusions The pressure of myocardial preservation from 30?mmHg to 60?mmHg is safe and effective in infants undergoing open heart surgery. The infusion pressure of 45?mmHg may be the best.