Heaton J P, Salerno T A
Ann Thorac Surg. 1983 May;35(5):530-4. doi: 10.1016/s0003-4975(10)60427-4.
A prospective analysis of myocardial temperatures (septum, left and right atria, and right ventricle) in coronary operations was carried out in nonvented human hearts during a single period of aortic cross-clamping for construction of all anastomoses, proximal and distal. Also a comparison was made of normothermic versus hypothermic perfusion during cardiopulmonary bypass (CPB). Results indicate that (1) immediately after cross-clampling and infusion of the cardioplegic solution, the septal temperature was identical for hypothermic and normothermic perfusion; (2) at 20 minutes of clamping, however, hypothermic patients had lower septal temperatures than normothermic patients; and (3) at the end of the cross-clamping period, the septal temperature was lower in hypothermic hearts. The left and right atrial and right ventricular temperatures were lower throughout CPB in patients with hypothermic perfusion. It is concluded that if a single period of aortic cross-clamping under cardioplegic arrest is to be used for construction of all anastomoses in nonvented hearts during a coronary operation, core hypothermia is necessary and should be maintained until the aorta is unclamped. The surgeon cannot rely on cold slush and cardioplegia alone to cool the heart while the proximal anastomoses are being performed, since blood from the bronchial (left atrium) and systemic (right atrium) circulations warms the heart.
在冠状动脉手术中，对未通气的人体心脏在单次主动脉交叉阻断期间（用于构建所有近端和远端吻合口）的心肌温度（室间隔、左心房、右心房和右心室）进行了前瞻性分析。此外，还比较了体外循环（CPB）期间常温灌注与低温灌注的情况。结果表明：（1）在交叉阻断并注入心脏停搏液后，低温灌注和常温灌注患者的室间隔温度相同；（2）然而，在阻断20分钟时，低温灌注患者的室间隔温度低于常温灌注患者；（3）在交叉阻断期结束时，低温心脏的室间隔温度更低。在低温灌注患者的整个CPB过程中，左、右心房和右心室的温度均较低。得出的结论是，如果在冠状动脉手术期间，要在未通气的心脏中使用单次主动脉交叉阻断并在心搏停止状态下构建所有吻合口，核心低温是必要的，并且应维持到主动脉松开。在进行近端吻合时，外科医生不能仅依靠冷灌洗和心脏停搏液来冷却心脏，因为来自支气管（左心房）和体循环（右心房）的血液会使心脏升温。
