Yilik Levent, Ozsoyler Ibrahim, Yakut Necmettin, Emrecan Bilgin, Yasa Haydar, Calli Aylin Orgen, Gurbuz Ali
Department of Cardiovascular Surgery, Ataturk Education and Research Hospital, Izmir, Turkey.
Tex Heart Inst J. 2004;31(4):392-7.
Some damage to the capillaries and increase in myocardial edema have been shown when retrograde cardioplegia perfusion pressure exceeds 40-50 mmHg, or possibly when it falls within this pressure interval. To avoid these complications, we designed a very simple delivery method for retrograde cardioplegia: passive continuous infusion by gravitational force alone. From August 2002 through April 2003, 147 patients undergoing elective coronary artery bypass surgery were randomly allocated into 2 groups. In both groups, isothermic blood cardioplegic solution was infused continuously in a retrograde fashion, after antegrade cardioplegic arrest. Group 1 (n=76) received retrograde infusion passively by gravitational force, while Group 2 (n=71) received retrograde infusion from a manually controlled pressure bag, with the pressure maintained at about 40 mmHg. Myocardial biopsy specimens were taken just before the aorta was declamped, and myocardial edema was scored upon histopathologic examination. Postoperative myocardial damage was evaluated with periodic measurements of CK-MB isoenzyme and cardiac troponin T levels. We recorded cardioplegic infusion pressures and rates, and the total amount of potassium administered. The mean cardioplegic infusion pressures and rates, total potassium levels, and cardioplegic solution amounts were significantly lower in Group 1 than Group 2. Histologic observations revealed significantly less myocardial edema in Group 1. There were no differences between groups in CK-MB isoenzyme or cardiac troponin T levels, mortality, or morbidity. Retrograde continuous infusion of isothermic blood cardioplegic solution by gravitational force alone appears to provide satisfactory myocardial protection and to eliminate the harmful effects of higher pressures upon the myocardium.
当逆行性心脏停搏灌注压力超过40 - 50 mmHg时，或者可能当压力处于这个区间时，已显示出毛细血管有一些损伤且心肌水肿增加。为避免这些并发症，我们设计了一种非常简单的逆行性心脏停搏给药方法：仅靠重力进行被动连续输注。从2002年8月至2003年4月，147例行择期冠状动脉搭桥手术的患者被随机分为2组。两组均在顺行性心脏停搏后以逆行方式持续输注等温血液心脏停搏液。第1组（n = 76）通过重力被动接受逆行输注，而第2组（n = 71）通过手动控制的压力袋接受逆行输注，压力维持在约40 mmHg。在主动脉松开前取心肌活检标本，并在组织病理学检查时对心肌水肿进行评分。术后心肌损伤通过定期测量CK - MB同工酶和心肌肌钙蛋白T水平进行评估。我们记录了心脏停搏液输注压力和速率以及钾的给药总量。第1组的平均心脏停搏液输注压力和速率、总钾水平以及心脏停搏液量均显著低于第2组。组织学观察显示第1组的心肌水肿明显较少。两组在CK - MB同工酶或心肌肌钙蛋白T水平、死亡率或发病率方面没有差异。仅靠重力逆行连续输注等温血液心脏停搏液似乎能提供令人满意的心肌保护，并消除较高压力对心肌的有害影响。
