体外循环中微温血、冷血心肌保护液对心肌保护作用的比较

272中国心血管病研究杂志2005年4月第3卷第4期ChineseJournalofC~'diovascularReviewApril2005，Vo1．．3，No．4体外循环中微温血、冷血心肌保护液对心肌保护作用的比较210029江苏南京市，南京医科大学第一附属医院胸心外科赵向东秦建伟邵永丰【关键词】心肌保护液；瓣膜置换术；心肌保护；磷酸肌酸激酶同工酶；心肌钙蛋白一I【摘要】目的观察微温血与冷血心肌保护液对瓣膜置换术患者的心肌保护作用。方法3O例行二尖瓣或主动脉瓣置换术者随机分为两组，分别经主动脉根部每20～30rain间断顺行灌注微温血或冷血心肌保护液。主动脉阻断前、体外循环结束后6h、16h分别测血气分析、磷酸肌酸激酶同工酶(CK—MB)、心肌钙蛋白一I(rn—I)。结果主动脉阻断前血气、CK—MB、cTn—I两组无显著差异，体外循环结束后6h、16h微温血组较冷血组各项指标低有显著差异。结论微温血较冷血心肌保护液对二尖瓣置换术者缺血再灌注心肌功能有显著保护作用。AssessmentofthemyocardialprotectionefectofantegradetepidbloodcardiopleoainMVRbymeasm~filereleaseofbiochemicalmarkersZhaoXiangdong，QinJianwei，ShaoYongfengDepartmentofCardiothoracicSurgery，theFirstAfiliatedHospitalofNJMU，Nanjing210029，China[Keywords]cardioplgia；mitralvalvereplacement(MVR)；myocardiacprotection；creatininekinaseMB(CK—MB)；cartdiactroponin—I(c1—I)【Ab茜】Objective：Intermittenttepidbloodcardioplegiahasbeenreportedasavaluablealternativeformyocar—dialprotectionincardiacsurgery，however，conflictingexperimentaldatahavebeenpublished．Thepurposeofthisstudyistoagse88thecfimcalefectivenessofintermitenttepidcardioplegiainvalvereplacement(MVR)．MethodsWemeasuredthereleaseofcardiactroponin—I(cTh—I)，ahighlysensitiveandspecificmarkerofmyocardialdamage，andcreatinekinaseMBisoenzyme(CK—MB)，in15patientswhounderwentMVRwithantegradeintermitenttepidbloodcardioplegia(26℃)，incomparisionwith15patientswhounderwentMVRwithantegradeintermittentcoldbloodcantioplegia(6oC)，beingthecoldgroup．Bloodsamplesweretakentodeterminethe~rulnconcentrationsofcTn—IandCK—MBbeforetheaorticcro88一clamp，then6hand16haftertheterminationofcanliopulmonarybypass(CPB)．ResultsThelevelofcTn—IandCK—MBbeforeaorticcross-clampisnosignificantbetweentwogroups．TheserumcTn—IandCK—MBafterCPBwassignificantlylowerinthetepidgroupthaninthecoldgroup．ConclusionIntermit-tentantegradetepidbloodcardioplegiashowefectivemyocardialprotectioninMVR．中图分类号R654．1文献标识码B文章编号1672—5301(200'5)04-0272-3过去有文献报道，温血(35℃)和冷血(8℃)心肌保护液对心肌的保护作用，但对微温血(26℃)对心肌保护作用研究的报道则较少。2003年10月～20o4年5月我们比较了30例二尖瓣或主动脉瓣置换手术的术中灌注方法，以探讨体外循环中微温血、