Oslo Heart Center, Division of Cardiovascular and Respiratory Medicine and Surgery, Oslo University Hospital, Rikshospitalet, Box 2684, St. Hanshaugen, 0131 Oslo, Norway.
Eur J Cardiothorac Surg. 2010 Dec;38(6):745-9. doi: 10.1016/j.ejcts.2010.03.052. Epub 2010 May 7.
Although experimental studies have indicated that blood cardioplegia may be superior to crystalloid cardioplegia for myocardial protection, clinical data still remain uncertain. In a previous randomised study from our institution, including 1440 patients undergoing coronary artery bypass grafting (CABG), no beneficial effects of blood cardioplegia were seen in any relevant outcome variables. The investigation was therefore extended to a patient population having longer pump times and ischaemic periods.
Over a 48-month period, all patients undergoing aortic valve replacement with or without CABG performed by two surgeons, were prospectively randomised to receive either intermittent cold retrograde blood cardioplegia (group B) or intermittent cold retrograde crystalloid cardioplegia (group C) during aortic cross-clamping.
A total of 345 patients aged 28-90 years (median, 72 years) entered the study (group B, n=172, group C, n=173). All relevant demographic and operative variables were similar for both groups. As for the clinical course, no statistically significant differences were seen concerning spontaneous sinus rhythm after aortic declamping, use of inotropic drugs, duration of ventilatory support, bleeding and rate of allogeneic blood transfusions, perioperative myocardial infarction, episodes of atrial fibrillation, stroke or minor neurological dysfunction, renal function, infections, physical rehabilitation or mortality. Further, in the patients with the longest ischaemic times, no statistically significant differences between the groups could be demonstrated.
There were no indications that retrograde cold blood cardioplegia was superior to retrograde cold crystalloid cardioplegia patients undergoing aortic valve replacement, with or without CABG.
尽管实验研究表明，血心停搏液可能优于晶体停搏液，用于心肌保护，但临床数据仍不确定。在我们机构之前的一项随机研究中，包括 1440 例接受冠状动脉旁路移植术（CABG）的患者，血心停搏液在任何相关的结果变量中都没有显示出有益的效果。因此，该研究扩展到了一个泵时间和缺血时间较长的患者群体。
在 48 个月的时间里，由两位外科医生进行的主动脉瓣置换术（或不进行 CABG）的所有患者，前瞻性随机分为接受间歇性冷逆行血心停搏液（B 组）或间歇性冷逆行晶体心停搏液（C 组）在主动脉阻断期间。
共有 345 名年龄在 28-90 岁（中位数 72 岁）的患者入组（B 组 172 例，C 组 173 例）。两组的所有相关人口统计学和手术变量均相似。在临床过程方面，主动脉开放后窦性节律恢复、使用正性肌力药物、通气支持时间、出血和异体输血率、围手术期心肌梗死、心房颤动、中风或轻度神经功能障碍、肾功能、感染、身体康复或死亡率等方面，两组之间无统计学显著差异。此外，在缺血时间最长的患者中，两组之间也没有统计学显著差异。
在接受主动脉瓣置换术（或不进行 CABG）的患者中，逆行冷血心停搏液并不优于逆行冷晶体心停搏液，没有迹象表明。
