Jegaden O, Girard C, Finet G, Bouvier H, Vial C, Montagna P, Rumolo A, Mikaeloff P
Department of Cardiovascular Surgery, Hôpital Cardiologique, Bron, France.
J Cardiovasc Surg (Torino). 1991 Mar-Apr;32(2):233-8.
We evaluated myocardial protection with Hamburg oxygenated crystalloid cardioplegic solution in a double study. Part I was a prospective metabolic study, measuring myocardial adenosine triphosphate (ATP) and creatine phosphate (CP) contents before and after ischemia in 30 coronary bypass (CABG) patients. During ischemia, CP levels decreased significantly, whereas ATP did not. After 10 minute of reperfusion, mean ATP contents were 90% of preischemic values and CP levels increased to 85% of preischemic values. Spontaneous myocardial defibrillation was seen in 93.3% of patients. Part II included evaluation of early postischemic myocardial function in 228 patients, 48 with multiple valve replacement (MUVR) and 180 with CABG. Spontaneous myocardial defibrillation was seen in 90.3%. Cardiac index, measured before and 1 and 12 hours after surgery, increased significantly in the postischemic period (from 1.95 +/- 0.9 to 2.5 +/- 0.7 l/min m2 in MUVR, p 0.04; from 2.2 +/- 0.6 to 2.7 +/- 0.7 l/min/m2 in CABG, p 0.01). Myocardial infarction frequency was 3% among CABG patients, and unrelated to the number of distal anastomosis or to aortic cross-clamp time. Early postoperative mortality was 6.2% for MUVR and 0.5% for CABG. Thus, oxygenated cardioplegia with Hamburg solution preserves high-energy phosphate compounds and prevents ischemic injury, with excellent short-term clinical results.
我们在一项双阶段研究中评估了汉堡氧合晶体心脏停搏液对心肌的保护作用。第一阶段是一项前瞻性代谢研究，测量了30例冠状动脉搭桥术（CABG）患者缺血前后的心肌三磷酸腺苷（ATP）和磷酸肌酸（CP）含量。在缺血期间，CP水平显著下降，而ATP没有。再灌注10分钟后，平均ATP含量为缺血前值的90%，CP水平升至缺血前值的85%。93.3%的患者出现自发性心肌除颤。第二阶段包括对228例患者缺血后早期心肌功能的评估，其中48例进行多瓣膜置换术（MUVR），180例进行CABG。90.3%的患者出现自发性心肌除颤。在术后1小时和12小时以及手术前测量的心指数在缺血后阶段显著增加（MUVR患者从1.95±0.9升至2.5±0.7 l/min·m²，p<0.04；CABG患者从2.2±0.6升至2.7±0.7 l/min/m²，p<0.01）。CABG患者中心肌梗死发生率为3%，与远端吻合数量或主动脉阻断时间无关。MUVR术后早期死亡率为6.2%，CABG为0.5%。因此，汉堡溶液氧合心脏停搏液可保存高能磷酸化合物并预防缺血性损伤，短期临床效果极佳。
