Douville E C, Kratz J M, Spinale F G, Crawford F A, Alpert C C, Pearce A
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston 29425.
Ann Thorac Surg. 1992 Jul;54(1):56-61. doi: 10.1016/0003-4975(92)91140-5.
Retrograde cardioplegia administered through the coronary sinus has several documented advantages over antegrade cardioplegia but has been thought to provide inadequate right ventricular myocardial protection. We prospectively compared the effects of retrograde and antegrade cardioplegia on right ventricular performance in patients undergoing myocardial revascularization. Two groups of similar age, extent of disease, and preoperative left ventricular ejection fraction received retrograde (n = 16) or antegrade (n = 14) crystalloid cardioplegia. A right ventricular rapid-response thermistor catheter, previously developed and validated in our institution, was used to measure right atrial pressure, pulmonary artery pressure, right ventricular ejection fraction, end-diastolic volume index, and stroke volume index before bypass (baseline) and at several intervals after bypass. There were no differences in cross-clamp time, heart rate, cardiac enzymes, inotrope requirements, or arrhythmias between the two groups. Right ventricular parameters were equivalent in both groups at all time intervals except 30 minutes after bypass, at which time right ventricular end-diastolic volume index was lower (80 +/- 6 versus 93 +/- 6 mL/m2; p less than 0.05) and right ventricular stroke volume index was higher (35 +/- 3 versus 29 +/- 2 mL/m2, p less than 0.05) in the retrograde group compared with the antegrade group, indicating better right ventricular function with retrograde cardioplegia early after bypass. In both groups, right ventricular end-diastolic volume index was higher than baseline (p less than 0.05) during the first 4 hours after bypass. No other important differences were found.(ABSTRACT TRUNCATED AT 250 WORDS)
经冠状静脉窦逆行灌注心脏停搏液相对于顺行灌注心脏停搏液有多项已被证实的优势，但一直被认为对右心室心肌的保护不足。我们前瞻性地比较了逆行和顺行心脏停搏液对接受心肌血运重建患者右心室功能的影响。两组年龄、疾病程度和术前左心室射血分数相似的患者分别接受逆行（n = 16）或顺行（n = 14）晶体心脏停搏液灌注。使用先前在我们机构研发并验证的右心室快速反应热敏电阻导管，在体外循环前（基线）和体外循环后若干时间点测量右心房压力、肺动脉压力、右心室射血分数、舒张末期容积指数和每搏量指数。两组在阻断时间、心率、心肌酶、血管活性药物需求或心律失常方面无差异。除体外循环后30分钟外，两组在所有时间点的右心室参数均相当，此时逆行灌注组的右心室舒张末期容积指数较低（80±6 与 93±6 mL/m²；p<0.05），右心室每搏量指数较高（35±3 与 29±2 mL/m²，p<0.05），表明体外循环后早期逆行心脏停搏液对右心室功能的保护更好。两组在体外循环后的最初4小时内，右心室舒张末期容积指数均高于基线（p<0.05）。未发现其他重要差异。（摘要截断于250字）
