Yamamoto S, Ogawa K, Asada T, Higami T, Tsuruta H, Nakao M, Nakamura K
Department of Surgery, Kobe University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Jan;38(1):78-85.
From September 1983 to February 1987, 45 consecutive aortic valve operations were performed using the retrograde continuous cold blood cardioplegia (RCCBC) via the coronary sinus. Except one patient died of stuck valve after aortic and mitral valve replacements, 44 patients were subjected for this study and all survived patients were symptomatically improved. They were divided into two groups according to the aortic cross clamps time (ACCT). Group 1; 23 patients, ACCT within 120 minutes, and Group 2; 21 patients, ACCT exceeding 120 minutes. After the operation blood was taken periodically to check creatine phosphokinase (CPK) and its iso-enzyme creatine-kinase (CK-MB) and GOT etc. Then their levels were compared between the two groups. Although there seemed to be a tendency that the highest levels of these enzymes increase according to the ACCT, there was no significant difference in CK-MB level between the two groups. Judging from the operative results and the postoperative study of enzymatic level, RCCBC is safe and useful for aortic valve surgery, especially when long ACCT is necessary for correcting complicated lesions or when the coronary orifice is not suitable for coronary perfusion in aortic dissection.
1983年9月至1987年2月,连续45例患者经冠状静脉窦采用逆行持续冷血心脏停搏法(RCCBC)进行主动脉瓣手术。除1例患者在主动脉瓣和二尖瓣置换术后死于瓣膜卡瓣外,其余44例患者纳入本研究,所有存活患者症状均有改善。根据主动脉阻断时间(ACCT)将患者分为两组。第1组23例患者,ACCT在120分钟以内;第2组21例患者,ACCT超过120分钟。术后定期采血检查肌酸磷酸激酶(CPK)及其同工酶肌酸激酶(CK-MB)和谷草转氨酶(GOT)等,然后比较两组患者这些酶的水平。尽管这些酶的最高水平似乎有随ACCT增加而升高的趋势,但两组患者的CK-MB水平无显著差异。从手术结果和术后酶水平研究来看,RCCBC对主动脉瓣手术是安全有效的,尤其是在纠正复杂病变需要较长ACCT或主动脉夹层患者冠状动脉开口不适合冠状动脉灌注时。