Takaba T, Inoue K
First Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shingawa-ku, Tokyo 142-8666, USA.
Ann Thorac Cardiovasc Surg. 2000 Feb;6(1):3-8.
Both the certainty of anatomical repair and early complete recovery of cardiac function are essential elements of successful cardiac surgery. Successful operations require adequate visualization of the operative field, arrest and relaxation of the hearts and sufficient operative time. Extracorporeal circulation and aortic cross-clamping are necessary to maintain a bloodless field. However, interruption of coronary perfusion by the aortic clamp produces myocardial ischemic injury, and unclamping induces reperfusion injury. For years, hypothermia was the most commonly used strategy for myocardial protection. However, the practice of warm heart surgery under normothermic extra corporeal circulation has increased recently. Cardiac surgeons now have a variety of myocardial protection strategies from which to choose. We introduce here the history of myocardial protection and our own recent investigations.
解剖修复的确定性和心脏功能的早期完全恢复都是心脏手术成功的关键要素。成功的手术需要手术视野的充分显露、心脏的停搏和松弛以及足够的手术时间。体外循环和主动脉阻断对于维持无血手术视野是必要的。然而，主动脉阻断导致的冠状动脉灌注中断会产生心肌缺血性损伤，而松开阻断则会引发再灌注损伤。多年来，低温是最常用的心肌保护策略。然而，近年来在常温体外循环下进行心脏不停跳手术的做法有所增加。心脏外科医生现在有多种心肌保护策略可供选择。在此我们介绍心肌保护的历史以及我们自己最近的研究。
