Sirvinskas Edmundas, Nasvytis Linas, Raliene Laima, Vaskelyte Jolanta, Toleikis Adolfas, Trumbeckaite Sonata
Department of Cardioanesthesiology and ICU, Kaunas Medical University Hospital and Laboratory of Intensive Care and Circulation Research, Institute for Biomedical Research, Eiveniu g. 4, LT-50009 Kaunas-7, Lithuania.
Croat Med J. 2005 Dec;46(6):879-88.
To compare the myocardial effects of cardioplegia by warm blood, tepid blood, and cold crystalloid during coronary artery bypass grafting (CABG).
Patients undergoing CABG surgery at Kaunas University Hospital between 2000 and 2004 were randomized into three groups (n=156), receiving a different method of cardioplegia. Intermittent antegrade warm blood cardioplegia was used in 51 patients, tepid blood cardioplegia in 50 patients, and cold crystalloid cardioplegia in 55 patients. Mitochondrial function, myocardial ultrastructure, troponin T, and hemodynamic and clinical data were analyzed after surgery.
All cardioplegic methods similarly affected structural and functional properties of mitochondria and coupling of oxidative phosphorylation, and all lowered the capacity of mitochondria to synthesize ATP. Ultrastructure of myocytes showed slight to moderate injury in the cold crystalloid cardioplegia group. The concentration of troponin T was significantly lower in the warm blood cardioplegia group than in the tepid blood cardioplegia and cold crystalloid cardioplegia groups at 12 hours (0.8+/-0.1 ng/mL, 1.9+/-0.2 ng/mL, and 2.8+/-0.3 ng/mL, respectively; P<0.001) and 24 hours after surgery (1.0+/-0.1 ng/mL, 2.2+/-0.3 ng/mL, and 2.5+/-0.3 ng/mL, respectively; P<0.001). Echocardiographic examination after surgery revealed that the changes in the left ventricle diastolic function were similar in all groups, and that systolic function did not change. The warm blood cardioplegia group showed shorter duration of intubation and hospitalization. There were no differences in the need of catecholamine administration, incidence of complications, and duration of stay in the intensive care unit.
Intermittent antegrade warm blood cardioplegia provides better myocardial protection during CABG surgery, as assessed by the lower release of troponin T, lower fluid balance, shorter duration of tracheal intubation and hospital stay.
比较冠状动脉旁路移植术（CABG）期间温血、微温血和冷晶体停搏液对心肌的影响。
2000年至2004年在考纳斯大学医院接受CABG手术的患者被随机分为三组（n = 156），接受不同的心脏停搏方法。51例患者采用间歇性顺行温血停搏，50例患者采用微温血停搏，55例患者采用冷晶体停搏。术后分析线粒体功能、心肌超微结构、肌钙蛋白T以及血流动力学和临床数据。
所有停搏方法对线粒体的结构和功能特性以及氧化磷酸化偶联的影响相似，且均降低了线粒体合成ATP的能力。冷晶体停搏组心肌细胞超微结构显示轻度至中度损伤。术后12小时（分别为0.8±0.1 ng/mL、1.9±0.2 ng/mL和2.8±0.3 ng/mL；P<0.001）和24小时（分别为1.0±0.1 ng/mL、2.2±0.3 ng/mL和2.5±0.3 ng/mL；P<0.001）时，温血停搏组肌钙蛋白T浓度显著低于微温血停搏组和冷晶体停搏组。术后超声心动图检查显示，所有组左心室舒张功能变化相似，收缩功能未改变。温血停搏组插管和住院时间较短。在儿茶酚胺使用需求、并发症发生率和重症监护病房停留时间方面无差异。
通过肌钙蛋白T释放较低、液体平衡较低、气管插管时间和住院时间较短评估，间歇性顺行温血停搏在CABG手术期间提供了更好的心肌保护。
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