血液停搏液在婴幼儿心脏手术中提供更好的保护。

Blood cardioplegia provides superior protection in infant cardiac surgery.

作者信息

Amark Kerstin, Berggren Håkan, Björk Kerstin, Ekroth Annica, Ekroth Rolf, Nilsson Krister, Sunnegårdh Jan

机构信息

Department of Pediatric Cardiology and Pediatric Anesthesia and Intensive Care, The Queen Silvia Children's Hospital, Göteborg, Sweden.

出版信息

Ann Thorac Surg. 2005 Sep;80(3):989-94. doi: 10.1016/j.athoracsur.2005.03.095.

DOI:10.1016/j.athoracsur.2005.03.095

PMID:16122471

Abstract

BACKGROUND

We hypothesized that blood cardioplegia preserves myocardial metabolism and function more effectively than St Thomas' crystalloid cardioplegia in infant cardiac surgery.

METHODS

Thirty infants with atrioventricular septal defects were randomly allocated to either blood or crystalloid intermittent cold (4 degrees C) cardioplegia. Arterial and coronary sinus blood was analyzed for lactate and oxygen. Cardiac output (thermodilution) and left ventricular function (echocardiography) were evaluated.

RESULTS

The lactate concentration in coronary sinus blood early after bypass was significantly higher after crystalloid cardioplegia than after blood cardioplegia (2.1 +/- 0.3 vs 1.3 +/- 0.1 mmol/L, p = 0.006), with a significant myocardial release of lactate after crystalloid but not after blood cardioplegia. Oxygen extraction (arterial-coronary sinus O2 content) was higher early after crystalloid cardioplegia (3.02 +/- 0.13 vs 2.35 +/- 0.22 mmol/L, p = 0.01), possibly reflecting a difference in oxygen debt. The cardiac index was higher after blood cardioplegia (4.9 +/- 0.3 vs 4.0 +/- 0.3 L/min(-1)/m(-2), p = 0.04) and echocardiographic grading of left ventricular function was better (4.1 +/- 0.17 vs 3.5 +/- 0.22 arbitrary units, p = 0.046).

CONCLUSIONS

This study indicates that blood cardioplegia preserves myocardial metabolism and function more effectively than crystalloid cardioplegia in infant cardiac surgery. The clinical significance of this finding is uncertain, but the more than 20% increase in cardiac index in the critical phase during weaning from bypass may be advantageous.

摘要

背景

我们假设在婴儿心脏手术中，血液停搏液比圣托马斯晶体停搏液能更有效地保护心肌代谢和功能。

方法

30例患有房室间隔缺损的婴儿被随机分配接受血液或晶体间歇性冷（4℃）停搏液。分析动脉血和冠状窦血中的乳酸和氧含量。评估心输出量（热稀释法）和左心室功能（超声心动图）。

结果

体外循环后早期，晶体停搏液组冠状窦血中的乳酸浓度显著高于血液停搏液组（2.1±0.3 vs 1.3±0.1 mmol/L，p = 0.006），晶体停搏液组有显著的心肌乳酸释放，而血液停搏液组没有。晶体停搏液后早期氧摄取（动脉血 - 冠状窦血氧含量差）更高（3.02±0.13 vs 2.35±0.22 mmol/L，p = 0.01），这可能反映了氧债的差异。血液停搏液组的心指数更高（4.9±0.3 vs 4.0±0.3 L/min⁻¹/m⁻²，p = 0.04），左心室功能的超声心动图分级更好（4.1±0.17 vs 3.5±0.22任意单位，p = 0.046）。