Diehl J T, Eichhorn E J, Konstam M A, Payne D D, Dresdale A R, Bojar R M, Rastegar H, Stetz J J, Salem D N, Connolly R J
Department of Cardiothoracic Surgery, New England Medical Center Hospital, Boston, MA 02111.
Ann Thorac Surg. 1988 Jun;45(6):595-602. doi: 10.1016/s0003-4975(10)64758-3.
The efficacy of retrograde coronary sinus cardioplegia (RCSC) administered through the right atrium compared with aortic root cardioplegia (ARC) has not been examined critically in patients undergoing coronary artery bypass grafting (CABG). Twenty patients having elective CABG were randomized prospectively to receive cold blood ARC (Group I, 10 patients) or cold blood RCSC (Group II, 10 patients). Patient demographics were similar in both groups. Ventricular function was assessed preoperatively by radionuclide ventriculography and postoperatively by simultaneous hemodynamic and radionuclide ventriculographic studies with volume loading. There was no change in ejection fraction (EF) (preoperative versus postoperative value) in Group I (50 +/- 6% versus 53 +/- 6%) but in group II, at similar peak systolic pressure and similar left ventricular end-diastolic volume index (LVEDVI), LVEF improved significantly (49 +/- 6% versus 60 +/- 12%, p less than 0.05). Postoperative ventricular function (stroke work index versus EDVI) for the left ventricle and right ventricle were similar in both groups. Evaluation of postoperative LV systolic function (end-systolic blood pressure versus end-systolic volume index) and diastolic function (pulmonary capillary wedge pressure versus EDVI) were also similar in both groups. Retrograde coronary sinus cardioplegia is as effective as ARC for intraoperative myocardial protection, and provides excellent postoperative function in patients undergoing elective CABG.
在接受冠状动脉旁路移植术（CABG）的患者中，尚未对经右心房给予逆行冠状静脉窦心脏停搏液（RCSC）与经主动脉根部给予心脏停搏液（ARC）的疗效进行严格研究。20例行择期CABG的患者被前瞻性随机分为两组，分别接受冷血ARC（I组，10例患者）或冷血RCSC（II组，10例患者）。两组患者的人口统计学特征相似。术前通过放射性核素心室造影评估心室功能，术后通过容量负荷下的同步血流动力学和放射性核素心室造影研究进行评估。I组射血分数（EF）（术前与术后值）无变化（50±6%对53±6%），但在II组，在相似的收缩压峰值和相似的左心室舒张末期容积指数（LVEDVI）情况下，左心室射血分数（LVEF）显著改善（49±6%对60±12%，p<0.05）。两组左心室和右心室的术后心室功能（每搏功指数与EDVI）相似。两组术后左心室收缩功能（收缩末期血压与收缩末期容积指数）和舒张功能（肺毛细血管楔压与EDVI）的评估也相似。逆行冠状静脉窦心脏停搏液在术中心肌保护方面与ARC一样有效，并且在接受择期CABG的患者中能提供良好的术后功能。
