Teoh K H, Christakis G T, Weisel R D, Fremes S E, Mickle D A, Romaschin A D, Harding R S, Ivanov J, Madonik M M, Ross I M
J Thorac Cardiovasc Surg. 1986 Jun;91(6):888-95.
Although blood cardioplegia provides excellent protection, myocardial metabolic recovery is delayed. To evaluate the benefits of a terminal warm cardioplegic infusion after cold blood cardioplegia, we performed a prospective randomized trial in 20 patients undergoing elective coronary bypass grafting. Eleven patients received cold blood cardioplegia and nine patients received cold blood cardioplegia and warm blood cardioplegia before cross-clamp removal (hot shot). The hot shot provided oxygen and removed excess lactate from the arrested heart. After the hot shot lactate was extracted by the heart and tissue adenosine triphosphate and glycogen concentrations were preserved. Atrial pacing and volume loading 3 and 4 hours postoperatively decreased myocardial lactate extraction after cold blood cardioplegia but increased lactate extraction after the hot shot. Left atrial pressures were higher at similar end-diastolic volumes (by nuclear ventriculography), which suggested decreased diastolic compliance after cold blood cardioplegia. Terminal warm blood cardioplegia accelerated myocardial metabolic recovery, preserved high-energy phosphates, improved the metabolic response to postoperative hemodynamic stresses, and reduced left atrial pressures.
尽管冷血心脏停搏液能提供出色的保护作用，但心肌代谢恢复会延迟。为评估冷血心脏停搏后终末温血心脏停搏液灌注的益处，我们对20例接受择期冠状动脉旁路移植术的患者进行了一项前瞻性随机试验。11例患者接受冷血心脏停搏液，9例患者在松开主动脉阻断钳之前接受冷血心脏停搏液及温血心脏停搏液（热灌注）。热灌注为停跳的心脏提供氧气并清除过量乳酸。热灌注后，心脏摄取乳酸，组织三磷酸腺苷和糖原浓度得以维持。术后3小时和4小时进行心房起搏及容量负荷时，冷血心脏停搏后心肌乳酸摄取减少，但热灌注后乳酸摄取增加。在相似的舒张末期容积（通过核素心室造影）下，左心房压力更高，这表明冷血心脏停搏后舒张期顺应性降低。终末温血心脏停搏液可加速心肌代谢恢复，保存高能磷酸盐，改善对术后血流动力学应激的代谢反应，并降低左心房压力。
