Faber Mizja M, Noordzij Peter G, Hennink Simon, Kelder Hans, de Vroege Roel, Waanders Frans G, Daeter Edgar, Stehouwer Marco C
Department of Extracorporeal Circulation, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Anaesthesiology, Intensive Care and Pain Management, St. Antonius Hospital, Nieuwegein, The Netherlands.
J Extra Corpor Technol. 2015 Dec;47(4):209-16.
Various techniques for administration of blood cardioplegia are used worldwide. In this study, the effect of warm blood cardioplegia administration with or without the use of a roller pump on perioperative myocardial injury was studied in patients undergoing coronary artery bypass grafting using minimal extra-corporeal circuits (MECCs). Sixty-eight patients undergoing elective coronary bypass surgery with an MECC system were consecutively enrolled and randomized into a pumpless group (PL group: blood cardioplegia administration without roller pump) or roller pump group (RP group: blood cardioplegia administration with roller pump). No statistically significant differences were found between the PL group and RP group regarding release of cardiac biomarkers. Maximum postoperative biomarker values reached at T1 (after arrival intensive care unit) for heart-type fatty acid binding protein (2.7 [1.5; 6.0] ng/mL PL group vs. 3.2 [1.6; 6.3] ng/mL RP group, p = .63) and at T3 (first postoperative day) for troponin T high-sensitive (22.0 [14.5; 29.3] ng/L PL group vs. 21.1 [15.3; 31.6] ng/L RP group, p = .91), N-terminal pro-brain natriuretic peptide (2.1 [1.7; 2.9] ng/mL PL group vs. 2.6 [1.6; 3.6] ng/mL RP group, p = .48), and C-reactive protein (138 [106; 175] μg/mL PL group vs. 129 [105; 161] μg/mL RP group, p = .65). Besides this, blood cardioplegia flow, blood cardioplegia line pressure, and aortic root pressure during blood cardioplegia administration were similar between the two groups. Administration of warm blood cardioplegia with or without the use of a roller pump results in similar clinically acceptable myocardial protection.
世界各地使用了多种血液心脏停搏液给药技术。在本研究中,我们研究了在使用最小体外循环(MECC)进行冠状动脉搭桥术的患者中,使用或不使用滚压泵进行温血心脏停搏液给药对围手术期心肌损伤的影响。连续纳入68例使用MECC系统进行择期冠状动脉搭桥手术的患者,并随机分为无泵组(PL组:不使用滚压泵进行血液心脏停搏液给药)或滚压泵组(RP组:使用滚压泵进行血液心脏停搏液给药)。在心脏生物标志物释放方面,PL组和RP组之间未发现统计学上的显著差异。术后心脏型脂肪酸结合蛋白在T1(进入重症监护病房后)达到最高生物标志物值(PL组为2.7 [1.5;6.0] ng/mL,RP组为3.2 [1.6;6.3] ng/mL,p = 0.63),高敏肌钙蛋白T在T3(术后第一天)达到最高生物标志物值(PL组为22.0 [14.5;29.3] ng/L,RP组为21.1 [15.3;31.6] ng/L,p = 0.91),N末端脑钠肽前体(PL组为2.1 [1.7;2.9] ng/mL,RP组为2.6 [1.6;3.6] ng/mL,p = 0.48),以及C反应蛋白(PL组为138 [106;175] μg/mL,RP组为129 [105;161] μg/mL,p = 0.65)。除此之外,两组在血液心脏停搏液给药期间的血液心脏停搏液流量、血液心脏停搏液管路压力和主动脉根部压力相似。使用或不使用滚压泵进行温血心脏停搏液给药均可产生相似的、临床上可接受的心肌保护效果。