Fabiani J N, Jebara V, Carpentier A
Cardiovascular Surgery Department, Hôpital Broussais, Paris, France.
Cardiovasc Drugs Ther. 1990 Aug;4 Suppl 4:797-803. doi: 10.1007/BF00051277.
Perioperative myocardial protection constitutes one of the major advances of modern cardiac surgery, but perioperative assessment of its quality is difficult in clinical practice. This review details our approach to myocardial protection in specific situations, as well as the techniques we use to assess it in three different settings: Is distribution of antegrade cardioplegia homogeneous in patients presenting coronary artery stenosis? The problem was to determine if cardioplegic solutions used antegradely or retrogradely could represent a reliable echographic contrast for myocardial imaging in coronary artery disease patients and normal coronary artery patients, and further if significant differences of myocardial contrast exist between the two methods. Does warm reperfusion cardioplegia improve postoperative myocardial function in patients with an ejection fraction (EF) less than 35%? Pre- and postoperative hemodynamic workup with construction of Starling curves were used to answer this question. Does reperfusion of ischemic hearts induce free radical formation in humans? Deleterious effects of reperfusion are usually determined by studying the effects of free radicals on the myocardium, by determining the concentrations of substances that reflect the degree of membrane phospholipid destruction. However, the specificity and the sensitivity of such assays are low. We recently described white cell chromosomal aberrations secondary to free radical formation, after ischemic and reperfusion injury. Values obtained are expressed as the percentage of the total number of chromosomes. Although specialized laboratory techniques are required, this test is highly accurate.
围手术期心肌保护是现代心脏外科的主要进展之一，但在临床实践中，对其质量进行围手术期评估却很困难。本综述详细介绍了我们在特定情况下进行心肌保护的方法，以及我们在三种不同情况下用于评估心肌保护的技术：在存在冠状动脉狭窄的患者中，顺行性心脏停搏液的分布是否均匀？问题在于确定顺行或逆行使用的心脏停搏液是否能作为冠心病患者和正常冠状动脉患者心肌成像的可靠超声造影剂，以及这两种方法之间心肌造影是否存在显著差异。对于射血分数（EF）小于35%的患者，温血再灌注心脏停搏液是否能改善术后心肌功能？通过术前和术后的血流动力学检查并构建斯塔林曲线来回答这个问题。缺血心脏的再灌注是否会在人体中诱导自由基形成？再灌注的有害影响通常通过研究自由基对心肌的影响，通过测定反映膜磷脂破坏程度的物质浓度来确定。然而，此类检测的特异性和敏感性较低。我们最近描述了缺血和再灌注损伤后自由基形成导致的白细胞染色体畸变。所得值以染色体总数的百分比表示。虽然需要专门的实验室技术，但这项检测非常准确。
