Fiore A C, Naunheim K S, Moskoff M E, Langreder S K, Barner H B
Department of Surgery, St. Louis University Medical Center, MO 63110-0250.
Ann Thorac Surg. 1991 Oct;52(4):1014-20. doi: 10.1016/0003-4975(91)91270-6.
The efficacy of coronary sinus cardioplegia administered into the right atrium has not been fully defined. Thirty-two consecutive patients undergoing elective myocardial revascularization were prospectively assigned to receive cold blood cardioplegia exclusively into the aortic root (15 patients) or the right atrium (17 patients). The two groups were similar with respect to age, ventricular function, severity of coronary disease, cross-clamp time, and mean infusate volume and temperature. Completeness of revascularization was greater in the aortic root cardioplegia group (p less than 0.007). The mean septal temperature and time to achieve electromechanical arrest was greater in the right atrial cardioplegia group (p less than 0.05). The right ventricular temperature and the release of myocardial isoenzyme were similar in both groups. Left and right ventricular stroke work index was preserved equally in both cohorts. Volume loading studies performed immediately after termination of bypass suggested better left ventricular function in the aortic root cardioplegia group. Myocardial performance with a loading challenge assessed late postoperatively was superior in the right atrial cardioplegia group (p less than 0.05). There were no differences between the groups with respect to clinical outcome. The data suggest that right atrial cardioplegia (1) possesses clinical safety equal to aortic root cardioplegia, (2) possesses inferior ventricular septal cooling, and (3) yields adequate preservation of both the right and left ventricles. We conclude that right atrial cardioplegia possesses no apparent advantage over aortic root delivery in the setting of elective myocardial revascularization.
经右心房给予冠状静脉窦心脏停搏液的效果尚未完全明确。32例连续接受择期心肌血运重建术的患者被前瞻性地分配，分别仅接受经主动脉根部（15例患者）或右心房（17例患者）给予冷血心脏停搏液。两组在年龄、心室功能、冠状动脉疾病严重程度、阻断时间、平均灌注液体积和温度方面相似。主动脉根部心脏停搏液组的血运重建完整性更高（p小于0.007）。右心房心脏停搏液组的平均室间隔温度和达到电机械性停搏的时间更长（p小于0.05）。两组的右心室温度和心肌同工酶释放相似。两组的左、右心室每搏作功指数均得到同等程度的保留。体外循环结束后立即进行的容量负荷研究表明，主动脉根部心脏停搏液组的左心室功能更好。术后晚期评估的负荷挑战下的心肌性能在右心房心脏停搏液组中更优（p小于0.05）。两组在临床结局方面无差异。数据表明，右心房心脏停搏液（1）具有与主动脉根部心脏停搏液相当的临床安全性，（2）室间隔降温效果较差，（3）能充分保护右心室和左心室。我们得出结论，在择期心肌血运重建的情况下，右心房心脏停搏液相对于经主动脉根部给药没有明显优势。
