摘要
随机将100例心脏瓣膜置换术患者分为治疗组(n=52),对照组(n=48)。治疗组于围手术期行系统的心肌保护治疗,对照组只限于术中低温和冷停搏液灌注作心肌保护。结果表明,治疗组自动复跳明显高于对照组(P<0.01),早期并发症及死亡率低于对照组(P<0.01),死亡率(P<0.05),我们认为强调围手术期心肌氧供需平衡的调节和治疗、麻醉方法的选择、体外循环技术操作及心脏复跳后一系列的心肌保护措施是手术成功的重要保证。
The objective of this retrospective study was to evaluate the myocardial protection of different periop erative procedures in 100 cases with heart-valve replacement (HVR) between 1980 and 1992. Before Feburary. 1989. HVRs of 48 cases (group Ⅰ) were undertaken with hypothermia (28C=30C) and cold cardioplegic solution (4C. 500ml). under morphine-diazepam-pancuronium anesthesia: following cardiac resuscitation, the procedures were performed including blood transfusion, diuresis, supplemental KCI. inotropic support with dopomine, norepincphrine and aramine. and continuous mechnical ventilation. Since 1989, the procedures were increased to be conducted in 52 cases (group Ⅱ) as followed: A. preoperative managements for achiving the optimum status of cardiac function: 1. oxygen therapy by mask. 2. antirhenmatic treatment for patients aged less than 35 years. 3. oral isosorbide and captopril for pulmonary hypertension, 4, infusion with fructose 1.6-diphusphatc and glucose-insulin-KC1 mixture. 5. clinical dose of digitora and diuretics for cardiac failure; B. methods during surgery: 1. anesthesia was induced with fentanyl, midazolam and pancuronium. and maintained with inhalation of nitrous oxide and infusion of fentanyl at 30-35μg/kg/min, 2, hy pothermia (24C-27C) and cold cardioplegic solution(600-1000ml) 3. immediately before the blockage of aorta was overcome. the artificial perfusion blood pressure was reduced; afterwards, it was gradually recovered, in order to prevent myocardium from injury of reperfusion. 4. intra-and extracoporal circulations worked together over half of blokage time of arota, to improve myoardial oxygen delivery; C. treatments in early postoperative stage: 1. continuous positive end-expiratory pressure ventilation, 2. infusion with magnesium-potassium aspartyl: and the others were similar to those before 1989. As compared with those in group 1. the rate of spontanous restoration of beats increased significantly (P<0.01). and the incidences of complications and mortality were obviously reduc
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
1996年第1期21-23,共3页
Chinese Journal of Anesthesiology
