摘要
背景:体外循环下冠状动脉搭桥的远期效果优于常温冠状动脉搭桥。对于严重冠脉狭窄患者,单纯经主动脉根部顺行灌注心肌保护效果欠佳,如何取得良好的心肌保护效果成为影响搭桥效果的关键因素之一。目的:比较体外循环下应用不同停跳液灌注方法对冠状动脉移植搭桥患者心肌的保护作用。方法:23例冠状动脉移植搭桥患者,根据停跳液灌注方法的不同分为主动脉根部灌注组;主动脉根部灌注+冠状动脉桥灌注组;主动脉根部灌注+经冠状静脉窦逆行灌注组。分别于搭桥前、体外循环30 min、升主动脉开放后5 min、2 h、6 h、24 h取血标本测量血清肌钙蛋白Ⅰ、磷酸肌酸激酶和磷酸肌酸激酶同工酶水平,记录体外循环时间、升主动脉阻断时间、升主动脉开放后心脏复跳情况、搭桥后正性肌力药物的应用情况、气管插管拔管时间及ICU停留时间等临床监测指标。结果与结论:肌钙蛋白Ⅰ复灌后2-24 h;CK复灌后5 min到24 h;磷酸肌酸激酶同工酶复灌后6,24 h,主动脉根部灌注+冠脉桥灌注组与主动脉根部灌注+经冠状静脉窦逆行灌注组明显低于主动脉根部灌注组(P<0.05)。心脏自动复跳率及多巴胺应用等临床监测指标3组比较差异无显著性意义。结果表明,应用心脏停跳液进行冠状动脉顺行性灌注的同时结合冠状动脉桥灌注或经冠状静脉窦逆行灌注,对心脏体外循环冠状动脉移植搭桥可取得良好的心肌保护效果。
BACKGROUND：On-pump coronary artery bypass has better long-term effects than off-pump coronary artery bypass. For patients with severe coronary artery stenosis, antegrade perfusion simply via the aortic root is ineffective in myocardial protection, and how to get a good myocardial protection has become one of the key factors affecting the bypass effects. OBJECTIVE：To compare the myocardial protection role of different perfuse ways for cardioplegia in the process of coronary artery bypass graft surgery under cardiopulmonary bypass. METHODS：Twenty-three patients undergoing coronary artery bypass graft surgery were divided into three groups according to different perfuse ways：antegrade perfusion group, antegrade combined with graft cardioplegia perfusion group and antegrade combined with retrograde perfusion roup. Blood samples were taken to test the levels of serum cardiac troponin I, creatine kinase and MB isoenzyme of creatine kinase before operation, 30 minutes after the beginning of cardiopulmonary bypass, 5 minutes, 2 hours, 6 hours and 24 hours after reperfusion. The amount of vaso-active drugs, postoperative cardiac auto-rebeating rate, cardiopulmonary bypass time, myocardial ischemic time, extubation time and ICU stay time were recorded. RESULTS AND CONCLUSION：The serum levels of cardiac troponin I were significantly lower in the cardioplegia perfusion and retrograde perfusion groups than that in the antegrade perfusion group after＆amp;nbsp;reperfusion 2 hour to 24 hours （P〈0.05）. The levels of creatine kinase were significantly lower in the cardioplegia perfusion and retrograde perfusion groups after reperfusion 5 minutes to 24 hours （P〈0.05）. The levels of MB isoenzyme of creatine kinase were significantly lower in the cardioplegia perfusion and retrograde perfusion groups after reperfusion 6 hours to 24 hours （P〈0.05）. There were no significant differences in the postoperative cardiac auto-rebeating rate and the amount of vaso-active drugs used among the three groups. These
出处
《中国组织工程研究》
CAS
北大核心
2015年第7期1112-1116,共5页
Chinese Journal of Tissue Engineering Research
