Allen Bradley S
Division of Acute Care Surgery, Department of Surgery, USC Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, CA, USA.
Eur J Cardiothorac Surg. 2020 Feb 1;57(2):263-270. doi: 10.1093/ejcts/ezz215.
The goals of a cardiac surgical procedure are both technical excellence and complete protection of cardiac function. Cardioplegia is used almost universally to protect the heart and provide a quiet bloodless field for surgical accuracy. Yet, despite the importance of myocardial protection in cardiac surgery, manuscripts or dedicated sessions at major meetings on this subject have become relatively rare, as though contemporary techniques now make them unnecessary. Nevertheless, septal dysfunction and haemodynamic support (inotropes, intra-aortic balloon pump, assist devices) are common in postoperative patients, indicating that myocardial damage following cardiac surgery is still prevalent with current cardioplegic techniques and solutions. This article first describes why cardiac enzymes and septal function are the ideal markers for determining the adequacy of myocardial protection. It also describes the underappreciated consequences of postoperative cardiac enzyme release or septal dysfunction (which currently occurs in 40-80% of patients) from inadequate protection, and how they directly correlate with early and especially late mortality. Finally, it reviews the various myocardial protection techniques available to provide a detailed understanding of the cardioplegic methods that can be utilized to protect the heart. This will allow surgeons to critically assess their current method of protection and, if needed, make necessary changes to provide their patients with optimal protection.
心脏外科手术的目标包括技术精湛以及对心脏功能的全面保护。心脏停搏液几乎被普遍用于保护心脏，并为手术操作的精确性提供一个安静的无血视野。然而，尽管心肌保护在心脏外科手术中至关重要，但关于这个主题的手稿或在主要会议上的专门会议却变得相对少见，仿佛当代技术现在已使它们不再必要。尽管如此，间隔功能障碍和血流动力学支持（强心剂、主动脉内球囊泵、辅助装置）在术后患者中很常见，这表明心脏手术后的心肌损伤在当前的心脏停搏技术和解决方案下仍然普遍存在。本文首先描述了为什么心脏酶和间隔功能是确定心肌保护是否充分的理想标志物。它还描述了由于保护不足导致的术后心脏酶释放或间隔功能障碍（目前在40%至80%的患者中出现）的未被充分认识的后果，以及它们如何与早期尤其是晚期死亡率直接相关。最后，它回顾了各种可用的心肌保护技术，以详细了解可用于保护心脏的心脏停搏方法。这将使外科医生能够严格评估他们当前的保护方法，并在需要时做出必要的改变，为患者提供最佳保护。
