Kyösola K, Chambers D, Canković-Darracott S, Braimbridge M V
Cardio-Thoracic Unit, St. Thomas' Hospital, London, U.K.
Ann Chir Gynaecol. 1987;76(4):241-2.
Prolonged aortic cross-clamping (in excess of 120 min) was necessary in 154 cardiac surgical patients. St. Thomas' Hospital cardioplegia was used for myocardial preservation. Quantitative polarization microscopy enabling quantitative birefringence measurements to assess the change in birefringence of the muscle fibres in response to the addition of buffer containing ATP and calcium (i.e. myocardial contractility) was used to detect whether there had been any deterioration in right or left ventricular myocardium during the bypass period. 30 day survival was 90%, long-term (60 months) survival was 80%. In single valve replacements, patients with aortic valvular replacement had 100% survival up to 92 months, whereas patients with mitral valvular replacement had survival rates of 83% after 12 months and 27% after 60 months. Survival rates after 60 months were 89% for coronary artery bypass grafting, 80% for multiple valve replacements, and 74% for combined valvular and coronary artery bypass grafting surgery. Quantitative birefringence assessment of function showed that in the surviving patients 5% had functional deterioration during bypass whereas in the non-surviving patients 70% had functional deterioration. It may be concluded that after cardiac surgery necessitating prolonged aortic cross-clamping--once the initial operative problems are overcome--reasonable long-term results can be obtained by using St. Thomas' Hospital cardioplegia.
154例心脏外科手术患者需要长时间主动脉交叉钳夹（超过120分钟）。采用圣托马斯医院心脏停搏液进行心肌保护。使用定量偏振显微镜进行定量双折射测量，以评估肌肉纤维双折射随含ATP和钙的缓冲液添加（即心肌收缩力）的变化，来检测体外循环期间右心室或左心室心肌是否出现任何恶化。30天生存率为90%，长期（60个月）生存率为80%。在单瓣膜置换术中，主动脉瓣置换患者92个月内生存率为100%，而二尖瓣置换患者12个月后生存率为83%，60个月后为27%。冠状动脉搭桥术后60个月生存率为89%，多瓣膜置换为80%，瓣膜置换与冠状动脉搭桥联合手术为74%。功能的定量双折射评估显示，存活患者中5%在体外循环期间出现功能恶化，而非存活患者中70%出现功能恶化。可以得出结论，在需要长时间主动脉交叉钳夹的心脏手术后，一旦克服了最初的手术问题，使用圣托马斯医院心脏停搏液可获得合理的长期效果。
