Bonchek L I, Burlingame M W, Vazales B E, Ferdinand N J
Division of Cardiothoracic Surgery, Lancaster General Hospital, PA.
Eur J Cardiothorac Surg. 1990;4(3):124-9. doi: 10.1016/1010-7940(90)90182-y.
Nine patients chosen at random received substrate enhanced cardioplegia (SECP) for early (less than 4 h) revascularization in acute infarction. A control group of 9 patients with similar clinical characteristics was chosen from the larger group revascularized concurrently with a noncardioplegic technique (NCP). There were no significant differences between the NCP and SECP groups respectively in preoperative clinical parameters such as age (62.8 vs. 62.3 years), sex (7 men, 2 women in both groups), ejection fraction (50% vs. 56%) or number of diseased vessels (2.1 vs 2.3). Intraoperative aortic clamp times were significantly shorter in NCP patients (11 vs. 38 min), and 4 NCP patients had no clamping. The internal mammary artery (IMA) was used in 6 NCP patients and 1 SECP patient (to a nonoccluded branch vessel). Postoperatively, NCP patients had higher peak CPK-MB (284 vs. 190 IU/l), longer use of inotropes (10 vs. 2.7 h) and intraaortic balloon pump (15 vs. 8 h), and a higher ejection fraction before discharge from hospital, but none of these differences were significant. SECP appears to provide better myocardial performance early postoperatively, but lasting benefits were not apparent in this subset of patients with early revascularization. Because the IMA has a powerful effect on long term survival but is very difficult to use with antegrade SECP, we continue to favor the IMA without SECP in hemodynamically stable, young patients (less than 65 years) who are revascularized early after infarction.
随机选取9例患者，在急性心肌梗死早期（小于4小时）行血运重建时接受底物强化心脏停搏液（SECP）灌注。从同时采用非心脏停搏技术（NCP）进行血运重建的更大患者组中选取9例临床特征相似的患者作为对照组。NCP组和SECP组在术前临床参数方面无显著差异，如年龄（62.8岁对62.3岁）、性别（两组均为7例男性，2例女性）、射血分数（50%对56%）或病变血管数量（2.1对2.3）。NCP患者的术中主动脉阻断时间显著更短（11分钟对38分钟），4例NCP患者未进行阻断。6例NCP患者和1例SECP患者（用于非闭塞分支血管）使用了乳内动脉（IMA）。术后，NCP患者的CPK - MB峰值更高（284 IU/L对190 IU/L），使用正性肌力药物的时间更长（10小时对2.7小时），主动脉内球囊反搏时间更长（15小时对8小时），出院前射血分数更高，但这些差异均无统计学意义。SECP似乎在术后早期能提供更好的心肌性能，但在这组早期血运重建的患者中，持久的益处并不明显。由于IMA对长期生存有强大作用，但与顺行性SECP联合使用非常困难，我们继续倾向于在梗死早期进行血运重建的血流动力学稳定的年轻患者（小于65岁）中不使用SECP而采用IMA。
