摘要
目的探讨温血高钾心脏停搏液诱导心脏停跳、术中冷血维持及终末温血灌注即“温-冷-温”技术在先天性心脏病(先心病)矫治术中的心肌保护作用。方法选择先心病矫治术30例,随机分为二组,即温血高钾停搏液诱导心脏停跳+冷维持+终末温血灌注组(温血组)和单纯冷血高钾停搏液组(冷血组)。通过对二组患者临床效果的观察,并于术前0.5h,术毕,术后3、24、72h和6d,分别从颈内静脉抽取血液测定肌酸激酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)、肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)。结果温血组的自动复跳率(100%)明显高于冷血组(61%);温血组术后机械通气时间及ICU停留时间明显短于冷血组。冷血组分别有2例出现一过性房室传导阻滞、室上性心动过速,4例发生低心输出量综合征,而温血组心脏复跳后无明显并发症。与冷血组比较,温血组在术毕,术后3、24、72h的血浆CK-MB、TnI水平明显降低,有统计学意义(P<0.01);温血组在术毕,术后3、24、72h的TNF-α、IL-6水平比冷血组明显降低,差异有统计学意义(P<0.01);而术后上述时间段的IL-10升高的幅度,温血组明显高于冷血组,差异有统计学意义(P<0.01)。结论温-冷-温灌注技术更有利于先心病矫治术中患者的心肌保护。
Objective To investigate the Myocardium Protection of warm induction and reperfusion blood cardioplegia on CHD patients. Methods Thiry CHD patients are divided into two groups randomly:Group of warm blood(warm induction and reperfusion byperclamic blood cardioplegia.n=15);Group of cold blood(n=15).The effect of myocardium protection of the two kinds of cardioplegic methods are evaluated by clinical outcome,cTnI,IL-6,IL-10,TMF-α and CK-MB.Serial jugular venous blood samples are attained 0.5h before induction,after cardiopulmonary bypass(CPB),postoperative 3hrs,24hrs,72hrs and 6th day,respectively. Results The percentage of myocardial auto-resusciation in the group of warm blood(100%) is significantly higher than that in the group of cold blood(61%).The period of postoperative mechanical ventilate and ICU staying in the group of warm blood is shorter than that in the group of cold blood obviously.Two cases with Ⅱ degree instantaneous transmitting obstacle,up-ventrical tachycardia and four cases with low cardiac output syndrom are found in the gtoup of cold blood,but none obvious complication are found in the group of warm blood after the myocardical auto-resusciation.Compared with the group of cold blood,the plasama concentration of CK-MB in the group warm blood is significantly lower at 3hrs,24hrs,72hrs(P<0.01).Compared with the group of cold blood,the concentration of TNF-α,IL-6 in the group of warm blood after cardiopulmonary bypass(CPB),and postoperative is significantly lower at 3hrs,24hrs,72hrs(P<0.01).The fluctuation of IL-10 with in the above time in the group of cold blood(P<0.01). Conclusion The technic of “warm-cool-warm”provdes more myocardium protection than simple cool blood cardioplegia in congenital heart disease patients.
出处
《中国心血管病研究》
CAS
2005年第1期32-35,共4页
Chinese Journal of Cardiovascular Research
关键词
先心病矫治术
心肌保护
温血诱导停搏
终末温血灌注
congenital heart disease rectification graft
myocardial protection
warm induction
warm reperfusion before clamp releasing
