Gundry S R, Sequeira A, Coughlin T R, McLaughlin J S
Department of Surgery, University of Maryland Medical System, Baltimore.
Ann Thorac Surg. 1989 Mar;47(3):384-90. doi: 10.1016/0003-4975(89)90378-0.
Conduction system disturbances after cardioplegia are well described. Our four-man group changed in mid-1987 from standard crystalloid cardioplegia (35 mEq/L of KCl) to blood cardioplegia (4 parts blood to 1 part cardioplegia) (18 mEq/L of KCl) based on experimental and clinical evidence that blood cardioplegia provides better myocardial protection. Shortly thereafter, we anecdotally noted increased conduction abnormalities. This prompted us to compare serially all patients undergoing coronary artery bypass grafting during 1987 for perioperative and late conduction system disturbances after either crystalloid or blood cardioplegia. Surgeons and techniques including topical cooling did not differ. Forty-one (23%) of 179 patients with crystalloid cardioplegia had conduction disturbances versus 141 (49%) of 289 patients with blood cardioplegia (p less than 0.001). Perioperative complete heart block requiring atrioventricular sequential pacing occurred in 20 patients with crystalloid cardioplegia versus 67 patients with blood cardioplegia (p less than 0.002), and atrioventricular block requiring permanent pacing was present in 4 and 12 patients (p less than 0.001), respectively. Left bundle-branch block was found in 8 patients given crystalloid cardioplegia and 28 patients with blood cardioplegia (p less than 0.05); right bundle-branch block, 12 and 68 patients (p less than 0.001); left anterior hemiblock, 8 and 37 patients (p less than 0.001); and interventricular conduction delay, 15 and 53 patients (p less than 0.005), respectively. Bifascicular block occurred in 4 patients receiving crystalloid cardioplegia versus 23 receiving blood cardioplegia (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
心脏停搏后传导系统紊乱已有详尽描述。我们四人小组于1987年年中从标准晶体心脏停搏液（氯化钾35 mEq/L）改用血液心脏停搏液（血液与心脏停搏液比例为4∶1）（氯化钾18 mEq/L），这是基于血液心脏停搏液能提供更好心肌保护的实验和临床证据。此后不久，我们偶然注意到传导异常增多。这促使我们对1987年所有接受冠状动脉旁路移植术的患者进行系列比较，观察晶体或血液心脏停搏液术后早期及晚期传导系统紊乱情况。外科医生及包括局部降温在内的技术并无差异。179例接受晶体心脏停搏液的患者中有41例（23%）出现传导紊乱，而289例接受血液心脏停搏液的患者中有141例（49%）出现传导紊乱（p<0.001）。晶体心脏停搏液组有20例患者术后早期需要房室顺序起搏的完全性心脏传导阻滞，血液心脏停搏液组有67例（p<0.002）；分别有4例和12例患者需要永久性起搏的房室传导阻滞（p<0.001）。接受晶体心脏停搏液的患者中有8例发现左束支传导阻滞，接受血液心脏停搏液的患者中有28例（p<0.05）；右束支传导阻滞分别为12例和68例（p<0.001）；左前分支传导阻滞分别为8例和37例（p<0.001）；室内传导延迟分别为15例和53例（p<0.005）。接受晶体心脏停搏液的患者中有4例出现双分支传导阻滞，接受血液心脏停搏液的患者中有23例（p<0.001）。（摘要截选至250词）
