【摘要】 目的通过监测分析浅低温体外循环心脏不停跳心内直视手术时,心肌组织中氧自由基和能量代谢情况以及血清中心肌酶学变化探讨更有效的心肌保护方法。方法风湿性心脏瓣膜病患者30例,随机分两组,每组15例。组Ⅰ:中度低温心脏停跳组,组Ⅱ:浅低温心脏不停跳组。各组于转机前、主动脉阻断钳开放即刻及开放后30min(不停跳组取相应时间)取少量右心耳全层心肌置液氮中保留,备测定丙二醛(MDA)、ATP和CP;另于术前、术后8h、16h、24h、48h取静脉血查心肌肌钙蛋白Ⅰ(cTnI)、CK及CK-MB。结果浅低温心脏不停跳组中各项指标均优于心脏停跳组。结论浅低温心脏不停跳手术由于明显地减轻了低温和缺血-再灌注损伤给心肌带来的损害,具有明确的心肌保护作用。更多还原

【Abstract】 Objective To investigate the myocardial protective effect in open heart surgery on the beating heart under mild hypothermia. Methods Thirty patients with congenital heart disease or acquired cardiac valvular disease were randomly divided into 2 groups. GroupⅠ: Moderate hypothermia ischemic cardiac arrest group (n=15), operations were performed during cardiopulmonary bypass(CPB) with ascending aorta being clamped,and cold cardioplegia(0～4 ℃) was infused. GroupⅡ: Open heart surgery on the beating heart under mild hypothermia. Hearts were kept beating during the repair in an unloading condition at mild hypothermia, While the arota was not clamped. The sample was incised and immersed immediately into liquid nitrogen for assays of malondialdehyde (MDA), ATP and CP at the times of CPB begins, ascending arota clamp removing and 30 minutes reperfusion (the time was set for groupⅡ accordingly). Serum was taken for assays of cardiac troponionⅠ(cTnI), CK and CK-MB at the time of preoperation, 8, 16, 24 and 48 hours after ascending aorta clamp removing. Results All indexes in groupⅡ were obviously superior to group Ⅰ. Conclusion Open heart surgery on the beating heart CPB at mild hypothermia may decrease myocardial damage if applied properly.更多还原