Page R D, Sharpe D A, Bellamy C M, Rashid A, Fabri B M
Cardiothoracic Centre, Liverpool, UK.
Eur J Cardiothorac Surg. 1992;6(9):461-7; discussion 468. doi: 10.1016/1010-7940(92)90241-o.
The requirement for hypothermia in myocardial protection has recently been questioned. Between October 1990 and May 1991, diastolic arrest was achieved using continuous perfusion with normothermic, hyperkalaemic blood in 257 consecutive patients undergoing cardiac surgery. The mean age was 59.8 +/- 9.3 years (range 28-84 years). Coronary artery surgery was performed in 210 patients, valve replacements in 18, combined procedures in 22, and 7 patients had miscellaneous procedures. Eleven patients (4.3%) had undergone previous cardiac surgery, and 65 (25.3%) required urgent or emergency operations. Hyperkalaemic blood (7-20 mmol/l) was delivered antegradely in 190 (72.8%) patients (mean aortic root pressure 60-80 mmHg), retrogradely in 62 (25.3%) patients (mean coronary sinus pressure less than 40 mmHg), and by a combined route in 5 (1.9%). Sinus rhythm returned immediately after removal of the aortic clamp in 235 (91.4%) patients. Weaning from bypass was achieved without circulatory support in 207 (82.5%) patients. Of 233 patients undergoing non-emergency coronary artery surgery, single valve or combined procedures, 11 died, giving an operative mortality of 4.7%. Of 155 patients with good left ventricular function requiring coronary artery surgery, 3 (1.9%) died. The in-hospital mortality for the group as a whole was 7.3%. Sixteen (6.2%) patients sustained perioperative myocardial infarctions; of these 6 died. We conclude that continuous, normothermic, hyperkalaemic arrest is a simple and safe method of myocardial protection. It may avoid the damage associated with hypothermia, ischaemia and reperfusion.
最近，心肌保护中对低温的需求受到了质疑。1990年10月至1991年5月期间，对257例连续接受心脏手术的患者采用常温、高钾血液持续灌注实现舒张期心脏停搏。平均年龄为59.8±9.3岁（范围28 - 84岁）。210例患者接受冠状动脉手术，18例进行瓣膜置换，22例进行联合手术，7例进行其他手术。11例患者（4.3%）曾接受过心脏手术，65例（25.3%）需要紧急或急诊手术。190例患者（72.8%）采用顺行灌注高钾血液（7 - 20 mmol/L）（平均主动脉根部压力60 - 80 mmHg），62例（25.3%）采用逆行灌注（平均冠状窦压力小于40 mmHg），5例（1.9%）采用联合灌注途径。235例患者（91.4%）在移除主动脉夹后立即恢复窦性心律。207例患者（82.5%）在无循环支持的情况下成功脱离体外循环。在233例接受非急诊冠状动脉手术、单瓣膜或联合手术的患者中，11例死亡，手术死亡率为4.7%。在155例左心室功能良好需要进行冠状动脉手术的患者中，3例（1.9%）死亡。该组患者的院内死亡率为7.3%。16例患者（6.2%）发生围手术期心肌梗死；其中6例死亡。我们得出结论，持续的常温、高钾心脏停搏是一种简单且安全的心肌保护方法。它可能避免与低温、缺血和再灌注相关的损伤。
