【摘要】 目的探讨浅低温不停跳瓣膜置换手术对心肌的保护作用。方法50例瓣膜置换手术病人分成实验组(不停跳组)和对照组(停跳组),每组25例。两组分别于体外循环前5min,体外循环后2、6、24和48h采血测定心肌肌酸磷酸激酶(CK)及其同功酶(CKMB)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)活性,并取右房心肌组织观察心肌超微结构的改变。结果对照组再灌注后CK、CKMB、LDH、AST比实验组明显增高(P<0.01),心肌细胞超微结构观察对照组变化明显,实验组基本不变。结论浅低温不停跳心脏瓣膜置换术能有效降低心脏手术患者CK、CKMB、LDH及AST活性,从而减少心肌缺血再灌注损伤。更多还原

【Abstract】 Objective To explore the protective effects of mild hypothermic cardiopulmonary bypass(CPB) on the myocardium of beating heart.Methods 50 patients undergoing valve replacement were randomly divided into an experimental group (beating heart group) and a control group (cold cardioplegic arrest heart group), with 25 patients each.The blood was sampled 5 min before CPB,at 2,6,24 and 48h during CPB,and after CPB for the measurements of creatine phosphokinase (CK),creatine phosphokinase isoenzyme(CK-MB),lactic dehydrogenase(LDH),aspartate amino transferase(AST).The myocardial tissues were taken from the right atrium for assessing ultrastructural changes.Results After reperfusion,the levels of CK,CK-MB,LDH and AST were significantly higher in control group than those in experimental group (P<0.01),and myocardial ultrastrctural changes were significant in control group. Conclusion The activities of serum CK,CK-MB,LDH and AST are effectively depressed in valve replacement with beating heart under mild hypothermic CPB,which may decrease myocardal ischemia-reperfusion injury.更多还原