Stiles Q R, Hughes R K, Lindesmith G G
J Thorac Cardiovasc Surg. 1977 Feb;73(2):176-80.
The effectiveness of cooling the subendocardial myocardium by five different methods was evaluated in a group of 100 patients. The most effective and consistent method to cool the heart was by total body hypothermia with the heat exchanger in the cardiopulmonary bypass system. Myocardial temperature became equal to vena caval blood temperature after only a one minute lag. The least effective methods of myocardial cooling were those in which a bath of chilled fluid enveloped the outside surface of the heart, with and without aortic cross-clamping. The drop in ventricular septal temperature was so small that topical hypothermia, by itself, may be worthless. Two methods in wich chilled fluid was perfused through the coronary system produced a significant lowering of myocardial temperature. One of these methods employs coronary perfusion with a cold cardioplegic solution in addition to total body hypothermia. It is our current choice for myocardial protection during cross-clamping of the ascending aorta.
在100名患者组成的一组中，评估了通过五种不同方法冷却心内膜下心肌的有效性。冷却心脏最有效且一致的方法是在体外循环系统中使用热交换器进行全身低温。心肌温度仅延迟一分钟后就与腔静脉血温度相等。最无效的心肌冷却方法是用冷流体浴包裹心脏外表面，无论是否进行主动脉交叉钳夹。室间隔温度下降非常小，以至于局部低温本身可能毫无价值。两种通过冠状动脉系统灌注冷流体的方法使心肌温度显著降低。其中一种方法除全身低温外，还使用冷心脏停搏液进行冠状动脉灌注。这是我们目前在升主动脉交叉钳夹期间进行心肌保护的选择。
