摘要
目的 评价心脏不停跳方法在主动脉瓣或联合瓣膜置换术中的应用价值。方法 经冠状静脉窦逆行持续灌注机器氧合血 ,使心脏在有节律的空跳情况下完成主动脉瓣和二尖瓣置换 ,或改为非置管顺行灌注 ,再行二尖瓣置换或其他合并症的处理 ,共 83例 (A组 ) ;随机选择 2 0例在间歇灌注冷血含钾心停搏液下完成手术 (B组 )。检测血液乳酸 (LA)、心肌磷酸肌酸激酶同工酶 (CPK MB)、心肌肌钙蛋白T(cTnT)、丙二醛 (MDA) ;观察前乳头肌超微结构改变 ;Swan Ganz管测定心排血量 (CO)。结果 LA、CPK MB、cTnT、ET 1、MDA的增高 ,B组与A组的差异有显著性 (P <0 0 5 )。A组心肌超微结构无明显变化 ;术后无多巴胺等正性肌力药物依赖和严重心律失常 ;81例恢复顺利 ,2例分别死于急性肾功能衰竭和感染性休克。B组均需每分钟 5～ 10 μg/kg多巴胺才能脱离体外循环机 ,9例术后使用临时起搏器 ,1例死于低心输出量综合征。结论 心脏不停跳主动脉瓣或联合瓣膜置换术 ,是一种较接近生理状态的心肌保护新方法 。
Objective: To estimate the value of aortic and combined mitral valve replacement in beating heart. Methods: Continuous retrograde coronary sinus perfusion on beating heart was used in 83 cases undergoing aortic valve or aortic valve combined with mitral valve replacement, without application of cardioplegia. After aortic valve replacement, the retrograde perfusion was changed to antegrade perfusion for mitral valve replacement or correction of the other deformities (group A). Cold blood cardioplegia solution (15℃) was infused at intervals in 20 cases( group B). The following parameters recorded: ①Lactate? CPK MB? cTnT? MDA in blood. ②Myocardial ultra structure. ③ Cardiac rhythm and cardiac output (CO). Results: All the biochemical values increased after CPB (P<0 05-0 01). Empty and beating heart of sinus rhythm was maintained in group A. The myocardial ultrastructure did not change significantly. The pumps were stopped smoothly at end of procedure. No postoperative low cardiac output syndrome and arrhythmias happened. 81 patients recovered smoothly. Two cases died. After weaning, all of patients in group B were supported by 5-10 μg·kg -1 ·min -1 dopamin. Transient pacing was used in nine cases. One case died from low cardiac output syndrome. Conclusion: This method is good in myocardial protection and way maintains a better physiologic state.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2002年第1期14-16,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
广西省教育厅资助项目 (编号 95 0 62 )
