Yamaguchi M, Imai M, Ohashi H, Hosokawa Y, Tachibana H, Ito H
Ann Thorac Surg. 1986 Jun;41(6):639-46. doi: 10.1016/s0003-4975(10)63079-2.
The effectiveness of systemic deep hypothermia for myocardial protection was evaluated retrospectively in 36 consecutive children who underwent total correction of tetralogy of Fallot in the four-year period 1980 to 1984. Moderate hypothermia combined with potassium-induced cold cardioplegia and topical cardiac cooling was employed in 16 patients (Group A), and deep hypothermia together with cold cardioplegia and topical cooling was used in 20 patients (Group B). A higher incidence of spontaneous defibrillation, a higher postoperative right ventricular cardiac index, a significant decrease in the maximal requirement of isoproterenol hydrochloride, a significant increase in the mean urinary output, and much better operative results were obtained in Group B compared with Group A. Postmortem histopathological examination of the heart in 3 patients in Group A disclosed various degrees of hypoxic change in the myocardium, which were more pronounced in the right ventricle than in the left ventricle. It is concluded that the myocardial protection obtained with cold cardioplegia and topical cooling under moderate hypothermia may well be insufficient for repair of tetralogy of Fallot, a condition characterized by increased non-coronary blood flow to the myocardium and abundant collateral bronchial flow. However, when combined with systemic deep hypothermia, such myocardial protection is quite safe and effective.
回顾性评估了1980年至1984年期间连续接受法洛四联症根治术的36例儿童患者全身深度低温对心肌保护的效果。16例患者采用中度低温联合钾诱导冷停搏液及局部心脏降温（A组），20例患者采用深度低温联合冷停搏液及局部降温（B组）。与A组相比，B组的自主除颤发生率更高、术后右心室心脏指数更高、盐酸异丙肾上腺素的最大需求量显著降低、平均尿量显著增加且手术效果更好。对A组3例患者的心脏进行尸检组织病理学检查发现，心肌存在不同程度的缺氧改变，右心室比左心室更明显。结论是，中度低温下冷停搏液及局部降温对心肌的保护作用可能不足以修复法洛四联症，该病症的特点是心肌非冠状动脉血流量增加且支气管侧支血流丰富。然而，当与全身深度低温联合使用时，这种心肌保护是相当安全有效的。
