Xu S C, Liu F M
Department of Anesthesia and Cardiopulmonary Bypass, Chinese Academy of Medical Sciences, Beijing.
Chin Med J (Engl). 1991 Jan;104(1):9-13.
It was demonstrated recently that a local renin-angiotensin system (RAS) exists in the heart and coronary vessels, and the angiotensin converting enzyme inhibitors can protect the heart from ischemia. Eight patients with NYHA class II-IV subjected to valve replacement were studied in protecting the heart from global ischemia with captopril during open heart surgery. After the ascending aorta was clamped, 500-1000 ml 4 degrees C modified St. Thomas No 1 cardioplegic solution containing 0.058-0.23 mmol/L captopril was perfused into coronary arteries under pressure until the electrocardiogram showed disappearance of myocardial electroactivity. The cardioplegic perfusion was repeated every 30 minutes thereafter during cardiopulmonary bypass (CPB). All the hearts rebeat after reperfusion either spontaneously or from defibrillation without any trouble. Three patients developed an A-V dissociation which returned to sinus rhythm or atrial fibrillation after a tiny dose of dopamine or isoprenaline intravenously. All the patients weaned from the CPB easily with a stable heart rate and a reasonable MAP. None of them needed inotropic support, even those with severe heart failure before operation did not either, and all recovered uneventfully.
最近有研究表明，心脏和冠状血管中存在局部肾素-血管紧张素系统（RAS），并且血管紧张素转换酶抑制剂可保护心脏免受缺血损伤。本研究对8例纽约心脏协会（NYHA）心功能II-IV级且接受瓣膜置换术的患者，在心脏直视手术期间使用卡托普利保护心脏免受全心缺血损伤。升主动脉阻断后，在压力下将500-1000ml含0.058-0.23mmol/L卡托普利的4℃改良圣托马斯1号心脏停搏液灌注到冠状动脉中，直至心电图显示心肌电活动消失。此后在体外循环（CPB）期间每30分钟重复一次心脏停搏液灌注。所有心脏在再灌注后均能自发复跳或经除颤后复跳，未出现任何问题。3例患者出现房室传导阻滞，经静脉注射小剂量多巴胺或异丙肾上腺素后恢复窦性心律或房颤。所有患者均能轻松脱离CPB，心率稳定，平均动脉压（MAP）合理。他们均无需使用正性肌力药物支持，即使术前患有严重心力衰竭的患者也无需支持，所有患者均顺利康复。
