Takeuchi K, Maida K, Munakata M, Yoshida S, Akimoto K, Suzuki S, Tanaka S
First Department of Surgery, Hirosaki University School of Medicine, Japan.
Kyobu Geka. 1999 Jun;52(6):467-70.
Increasingly complex techniques of cardiac surgery often require prolonged myocardial ischemia. We previously reported a better myocardial preservation with histidine containing cardioplegia (HBS) in human open heart surgery. To see a safety margin of this cardioplegia for prolonged myocardial preservation, this study was retrospectively done. One hundred twenty-six patients received either intermittent multidose (20-30 minute) cold blood cardioplegia (CBC) plus topical cooling (aotric cross clamp time (ACC) < 120 minutes, n = 63) or HBS (n = 63). HBS group was divided into two groups with either short ACC (< or = 120 minutes, HBS-S, n = 46) or long ACC (> 120 minutes, HBS-L, n = 17). Cardiac index (C.I.) and dopamin/dobutamine requirement were measured 3, 6, and 12 hours post-bypass. Incidence of homologous blood transfusion was also studied. There was two deaths due to LOS in HBS-S group; four patients in HBS group required 5 DC cardioversion, whereas six patients required a total of 12 DC cardioversion in CBC group. Functional recovery were significantly better with significantly lower inotropic requirements in HBS-S group than CBC group and HBS-L group. Although preoperative ejection fraction and C.I. were significantly lower in HBS-L group, post-operative cardiac function and inotropic requirements in HBS-L was comparable to that seen in CBC group. We conclude that the highly buffered histidine crystalloid cardioplegia solution provides effective myocardial preservation with a wider safety margin for prolonged myocardial preservation in open heart surgery.
日益复杂的心脏手术技术常常需要延长心肌缺血时间。我们之前报道过，在人类心脏直视手术中，含组氨酸心脏停搏液（HBS）能实现更好的心肌保护。为了探究这种心脏停搏液在延长心肌保护方面的安全边际，我们进行了这项回顾性研究。126例患者分别接受间歇性多剂量（20 - 30分钟）冷血心脏停搏液（CBC）加局部降温（主动脉交叉阻断时间（ACC）< 120分钟，n = 63）或HBS（n = 63）。HBS组又分为两组，即短ACC（≤120分钟，HBS - S，n = 46）或长ACC（> 120分钟，HBS - L，n = 17）。在体外循环后3、6和12小时测量心脏指数（C.I.）以及多巴胺/多巴酚丁胺需求量。还研究了同源输血的发生率。HBS - S组有2例因败血症死亡；HBS组有4例患者需要5次直流电复律，而CBC组有6例患者共需要12次直流电复律。HBS - S组的功能恢复明显更好，与CBC组和HBS - L组相比，其正性肌力药物需求量显著更低。尽管HBS - L组术前射血分数和C.I.显著更低，但其术后心脏功能和正性肌力药物需求量与CBC组相当。我们得出结论，高度缓冲的组氨酸晶体心脏停搏液在心脏直视手术中能提供有效的心肌保护，且在延长心肌保护方面具有更宽的安全边际。
