摘要
目的 通过与常规心脏停搏二尖瓣置换术的对比研究 ,评价心脏不停跳心瓣膜置换术的心肌保护作用。方法 2 4例风湿性心脏病行二尖瓣置换术患者随机分为两组 ,每组 12例。实验组 :采用心脏不停跳二尖瓣置换术 ;对照组 :采用常规心脏停搏二尖瓣置换术。于麻醉诱导后、升主动脉开放后 (或心内主要操作完成 ) 2小时、12小时、2 4小时、36小时、48小时和 72小时分别采中心静脉血 ,检测血清心肌肌钙蛋白 I(c Tn I)含量 ;观察心肌超微结构 ;记录心律失常情况、术后多巴胺用量、辅助通气时间和 ICU恢复时间等临床指标。 结果 升主动脉开放后 (或心内主要操作完成 ) 2小时、12小时、2 4小时和 36小时 ,实验组 c Tn I均较对照组低 (P<0 .0 5 ,0 .0 1) ;心肌组织超微结构观察对照组线粒体嵴间隙明显增宽 ,可见嵴断裂 ,实验组线粒体肿胀不明显 ,嵴无断裂。术后临床恢复情况与对照组比较 ,实验组发生心律失常例数少 ,多巴胺用量少 (P<0 .0 1) ,辅助通气和 ICU恢复时间短 (P<0 .0 5 )。 结论 浅低温心肺转流心脏不停跳心内直视手术可减轻心肌缺血 -再灌注损伤 ,有较好的心肌保护作用。
Objective To evaluate the effect on myocardial preservation of mitral valve replacement with beating heart, in comparison with that of mitral valve replacement with cardiac arrest. Methods Twenty-four patients with rheumatic heart valve disease who had undergone mitral valve replacement were divided into two groups at random. Experiment group( n =12): the patients underwent mitral valve replacement with beating heart. Control group( n =12):the patients underwent mitral valve replacement with the arrested hearts . Serum levels of cardiac troponin I (cTnI) was measured after anesthesia, and at 2h, 12h, 24h, 36h, 48 h and 72 h after aortic declamping or intra-cardiac manipulation finished. Myocardial ultrastructures were observed. The following clinical parameters were recorded, such as arrhythmia, the postoperative usage of dopamine, the hours of mechanical ventilation, etc. Results cTnI levels in experiment group were lower than those in control group at 2 h, 12 h, 24 h, 36 h after aortic declamping or intra-cardiac manipulation finished ( P <0.05,0.01). Crest interval of mitochondrion increased obviously in control group, and crest disruptions were also observed. In experiment group,only dim crest was observed. As compared with control group, arrhythmia and usage of dopamine were lesser in amount ( P <0.01), period of mechanical ventilation and staying in intensive care unit were shorter in experiment group ( P <0.05). Conclusion Beating heart on cardiopulmonary bypass with mild hypothermia could attenuate ischemia-reperfusion injury of myocardium, so it has better myocardial protection effects.
出处
《中国胸心血管外科临床杂志》
CAS
2002年第3期175-177,共3页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
湖北省教育厅科学基金资助项目 ( 2 0 0 0 B0 30 2 1)~~
