摘要
目的研究顺逆灌结合开放前温血灌注技术在冠状动脉搭桥术中应用的方法和效果。方法将30例冠心病患者随机分为两组：A组（顺逆灌结合开放前温血灌注组）15例，B组（顺灌组）15例。心肌保护方法：A组采用首次顺灌15ml／kg＋逆灌5ml／kg4：1冷含血心脏停搏液，之后每隔20—30分钟逆行灌注5～10ml／kg停搏液，开放主动脉阻断钳前3～5min开始逆行灌注温血直至开放；B组采用首次顺灌20ml／kg4：1冷合血心脏停搏液．之后每隔20～30分钟顺灌5～10ml／kg停搏液。，临床观察自动复跳率、术后呼吸机辅助时间、ICU停留时间。测围术期即体外循环（CPB）开始前、术后4h和术后24h动脉血中的心肌肌钙蛋白T（cTnT）、肌酸激酶（CK）、肌酸激酶同工酶（CK．MB）浓度。结果A组自动复跳率为93％，高于B组的67％。A组术后呼吸机辅助时间和ICU停留时间均明显短于B组。两组中的cTnT、CK、CK—MB浓度，在术后均逐步升高，与CPB开始前比较差异有统计学意义（P〈0．05），A组上升幅度小于B组，术后4h和术后24h两组中的cTnT、CK、CK—MB浓度的差异有统计学意义（P〈0．05）。结论在冠状动脉搭桥术中，采用顺逆灌结合开放前温血灌注技术，安全可靠，心肌保护效果优于常规的间断顺灌方法，值得临床推广应用。
Objective To study the effect of antegrade/retrograde cardioplegia combined with warm blood retrograde before releasing aortic cross-clamp on coronary artery bypass grafting. Methods Thirty patients underwent coronary artery bypass grafting were divided into two groups： antegrade/retrograde cardioplegia combined with warm blood retrograde before releasing aortic cross-clamp（ group A, n=15） and antegrade cardioplegia group （ group B, n = 15 ）. In group A, antegrade cool blood 15 - 20 ml/kg was infused followed by retrograde cardioplegia 5 -10 ml/kg every 20 -30 minutes, and then retrograde warm blood was infused before releasing aortic cross-clamp. In group B, antegrade cool blood 15 -20 ml/kg was infused followed by antegrade cardioplegia 5 - 10 ml/kg every 20 - 30 minutes. Clinical data including heart resuscitation, ventilation time, the time of ICU stay were recorded. Arterial blood was taken to measure the cardi- ac troponin T（ cTnT）, creatine kinase（ CK）, and creatine kinase MB（ CK-MB）, at the moment of CPB, 4 hours and 24 hours after operation. Results The automatically reset the jump rate of group A was 93%, which was significantly higher than that of group B （67%）. The ventilation time and the time of ICU stay was shorter in group A than those in group B. The concentrations of cTnT, CK and CKMB were increased obviously after operation in two groups at 4 hours and 24 hours after operation, and the values in group A were lower than that in group B （P 〈 0.05）. Conclusions In coronary artery bypass, the application of antegrade/retrograde cardioplegia combined with warm blood retrograde before releasing aortic cross- C ore effective than antegrade cardioplegia, is worthy to be applicated in clinic sion ; Coronary artery Cardiopulmonary bypass; Myocardial protection; Coronary sinus retrograde perfu- bypass grafting
出处
《中国实用医刊》
2012年第20期55-57,共3页
Chinese Journal of Practical Medicine
关键词
体外循环
心肌保护
冠状静脉窦逆行灌注
冠状动脉旁路移植术
Cardiopulmonary bypass
Myocardial protection
Coronary sinus retrograde perfusion
Coronary artery bypass grafting
