Chocron S, Kaili D, Yan Y, Toubin G, Latini L, Clement F, Viel J F, Etievent J P
Departments of Thoracic and Cardiovascular Surgery, Pharmacology, and Biostatistics, Saint-Jacques Hospital, Besançon, France.
J Thorac Cardiovasc Surg. 2000 Mar;119(3):610-6. doi: 10.1016/s0022-5223(00)70144-9.
In the field of intermittent antegrade blood cardioplegia, 3 levels of temperature are commonly used: (1) cold (8 degrees C); (2) tepid (29 degrees C); and (3) warm (37 degrees C). Given the 21 degrees C spread and the metabolic changes that can occur between cold (8 degrees C) and tepid (29 degrees C) cardioplegia, we thought it worthwhile to test a temperature halfway between the cold and tepid levels. The aim of this study was to test the quality of myocardial protection provided by intermediate lukewarm (20 degrees C) cardioplegia by comparing it with cold and warm cardioplegia. Protection was assessed by measuring cardiac troponin I release.
One hundred thirty-five patients undergoing coronary artery bypass grafting were enrolled in a prospective randomized trial comparing cold (8 degrees C), intermediate lukewarm (20 degrees C), and warm (37 degrees C) antegrade intermittent blood cardioplegia. Cardiac troponin I concentrations were measured in serial venous blood samples.
The total amount of cardiac troponin I released was significantly higher in the cold group (4.7 +/- 2.3 microg) than in the intermediate lukewarm (3.4 +/- 2.0 microg) or the warm (3.1 +/- 2.7 microg) groups. The cardiac troponin I concentration was significantly higher at hour 6 in the intermediate lukewarm group (1. 23 +/- 0.55 microg/L) than in the warm group (0.89 +/- 0.50 microg/L).
Intermittent antegrade intermediate lukewarm blood cardioplegia is appropriate and clinically safe. Cardiac troponin I release suggests that intermediate lukewarm cardioplegia is better than cold cardioplegia but less effective than warm cardioplegia in low-risk patients. We therefore recommend the use of warm cardioplegia in low-risk patients.
在间歇性顺行性血液心脏停搏领域，通常使用3种温度水平：（1）冷（8摄氏度）；（2）微温（29摄氏度）；（3）温（37摄氏度）。鉴于冷（8摄氏度）和微温（29摄氏度）心脏停搏之间21摄氏度的温差以及可能发生的代谢变化，我们认为测试介于冷和微温水平之间的中间温度是值得的。本研究的目的是通过将中间微温（20摄氏度）心脏停搏与冷和温心脏停搏进行比较，来测试其提供的心肌保护质量。通过测量心肌肌钙蛋白I释放来评估保护效果。
135例行冠状动脉旁路移植术的患者被纳入一项前瞻性随机试验，比较冷（8摄氏度）、中间微温（20摄氏度）和温（37摄氏度）顺行性间歇性血液心脏停搏。在连续的静脉血样本中测量心肌肌钙蛋白I浓度。
冷组（4.7±2.3微克）释放的心肌肌钙蛋白I总量显著高于中间微温组（3.4±2.0微克）或温组（3.1±2.7微克）。中间微温组在第6小时的心肌肌钙蛋白I浓度（1.23±0.55微克/升）显著高于温组（0.89±0.50微克/升）。
间歇性顺行性中间微温血液心脏停搏是合适且临床安全的。心肌肌钙蛋白I释放表明，在低风险患者中，中间微温心脏停搏优于冷心脏停搏，但不如温心脏停搏有效。因此，我们建议在低风险患者中使用温心脏停搏。
