Cheung E H, Arcidi J M, Jackson E R, Hatcher C R, Guyton R A
Carlyle Fraser Heart Center, Crawford Long Hospital, Emory University, Atlanta, Georgia 30365.
Circulation. 1988 Nov;78(5 Pt 2):III173-9.
Augmented right heart cooling (RHC) with bicaval cannulation, pulmonary artery venting, and intracavitary cooling has been advocated for prevention of right ventricular failure and supraventricular tachyarrhythmias after open heart surgery. To evaluate RHC, 78 patients undergoing coronary bypass surgery were prospectively randomized to receive added RHC (n = 38) or standard protection with single atrial cannulation (SC) (n = 40). RHC and SC patients were similar regarding right coronary artery occlusion (n = 10 and 12, respectively), number of grafts performed (3.7 +/- 1.0 and 3.4 +/- 0.9), and cross-clamp time per graft (10.2 +/- 1.8 and 9.8 +/- 2.3 minutes). RHC led to significantly lower right atrial (11.6 degrees +/- 1.0 degree vs. 19.5 degrees +/- 3.3 degrees C) and right ventricular (7.2 degrees +/- 1.9 degrees vs. 12.2 degrees +/- 1.9 degrees C) temperatures. There was no detectable deterioration in right heart function or left heart function in either group after cardiopulmonary bypass. Bypass time was longer in RHC patients (86.7 +/- 17.9 vs. 76.0 +/- 18.2 minutes, p less than 0.05). Technical problems related to multiple cannulation occurred in four RHC patients. After cross-clamp removal, creatine kinase-MB levels were significantly higher with RHC at 2 hours (14.2 +/- 7.6 vs. 6.4 +/- 4.6 IU/l, p less than 0.001), 12 hours (19.1 +/- 19.5 vs. 8.6 +/- 10.3 IU/l, p less than 0.005), and 24 hours (14.1 +/- 19.6 vs. 7.1 +/- 9.2 IU/l, p less than 0.05). Mortality and morbidity were similar in the two groups. In particular, supraventricular tachyarrythmias occurred in 11 (28.9%) RHC and 10 (25%) SC patients.(ABSTRACT TRUNCATED AT 250 WORDS)
双腔插管、肺动脉排气和心腔内降温的强化右心冷却（RHC）已被提倡用于预防心脏直视手术后的右心室衰竭和室上性快速心律失常。为了评估RHC，78例接受冠状动脉搭桥手术的患者被前瞻性随机分为接受附加RHC组（n = 38）或单心房插管（SC）标准保护组（n = 40）。RHC组和SC组在右冠状动脉闭塞情况（分别为n = 10和12）、移植血管数量（3.7±1.0和3.4±0.9）以及每根移植血管的阻断时间（10.2±1.8和9.8±2.3分钟）方面相似。RHC导致右心房温度（11.6℃±1.0℃对19.5℃±3.3℃）和右心室温度（7.2℃±1.9℃对12.2℃±1.9℃）显著降低。体外循环后两组的右心功能或左心功能均未检测到恶化。RHC组患者的体外循环时间更长（86.7±17.9对76.0±18.2分钟，p<0.05）。4例RHC患者出现与多根插管相关的技术问题。松开阻断钳后，RHC组在2小时（14.2±7.6对6.4±4.6 IU/l，p<0.001）、12小时（19.1±19.5对8.6±10.3 IU/l，p<0.005）和24小时（14.1±19.6对7.1±9.2 IU/l，p<0.05）时肌酸激酶-MB水平显著更高。两组的死亡率和发病率相似。特别是，11例（28.9%）RHC组患者和10例（25%）SC组患者发生了室上性快速心律失常。（摘要截断于250字）
