Shapira N, Kirsh M, Jochim K, Behrendt D M
J Thorac Cardiovasc Surg. 1980 Nov;80(5):647-55.
The myocardial protection achieved by blood cardioplegia was compared to that achieved by crystalloid cardioplegia in a randomized prospective series of patients having coronary bypass operations. Group BCP (n = 15) was protected with 10 degrees C blood containing potassium, 30 mEq/L; Group KCP (n = 9) by an electrolyte solution at 4 degrees C with mannitol, 25 gm/L, and potassium, 26 mEq/L, and group MgKCP (n = 9) by an electrolyte solution at 4 degrees C containing magnesium, 30 Meq/L, and potassium, 19.6 mEq/L. The three groups were comparable in regard to age, sex, preoperative left ventricular function, symptoms, propranolol use, previous myocardial infarction, number of vessels bypassed, and duration of ischemic arrest. In each patient cardiac output, left ventricular end-diastolic pressure (LVEDP), and maximum contractile element velocity (Vpm) were recorded before and after the ischemic period. All operations were performed in an identical manner with one continuous period of aortic cross-clamping averaging 52.9 minutes. No significant alterations in myocardial function were observed after ischemia within the BCP or KCP groups. However, patients receiving MgKCP had significant (p = 0.02) depression in Vpm from 2.86 +/- 7.8 to 2.04 +/- 3.6 second-1 and increase (p < 0.05) in LVEDP from 9.4 +/- 2.2 to 13.4 +/- 5.2 mm Hg. Analysis of variance between groups showed that Vpm decreased significantly (p < 0.05) and LVEDP increased significantly (p < 0.05) in the MgKCP group by comparison to the BCP group. Patients receiving BCP experienced spontaneous defibrillation more frequently (p < 0.02) and received nitroprusside postoperatively more often (p < 0.05) than patients in the other two groups. From these results we conclude that blood cardioplegia provides excellent protection during myocardial ischemia, probably better than one of the two crystalloid solutions tested but no better than the other crystalloid solution. Because the three solutions differed from one another in several respects, no conclusion can be reached about the efficacy of any one ingredient.
在一组接受冠状动脉搭桥手术的患者中，对血液停搏液与晶体停搏液所实现的心肌保护效果进行了随机前瞻性比较。血液停搏液组（BCP组，n = 15）采用含钾30 mEq/L的10℃血液进行心肌保护；钾晶体停搏液组（KCP组，n = 9）采用含甘露醇25 gm/L和钾26 mEq/L的4℃电解质溶液；镁钾晶体停搏液组（MgKCP组，n = 9）采用含镁30 mEq/L和钾19.6 mEq/L的4℃电解质溶液。三组在年龄、性别、术前左心室功能、症状、普萘洛尔使用情况、既往心肌梗死情况、搭桥血管数量以及缺血停搏时间方面具有可比性。在每位患者的缺血期前后记录心输出量、左心室舒张末期压力（LVEDP）和最大收缩成分速度（Vpm）。所有手术均以相同方式进行，主动脉交叉钳夹持续时间平均为52.9分钟。在BCP组或KCP组中，缺血后未观察到心肌功能有明显改变。然而，接受MgKCP治疗的患者Vpm从2.86±7.8显著下降（p = 0.02）至2.04±3.6秒-1，LVEDP从9.4±2.2显著升高（p < 0.05）至13.4±5.2 mmHg。组间方差分析表明，与BCP组相比，MgKCP组的Vpm显著降低（p < 0.05），LVEDP显著升高（p < 0.05）。接受BCP治疗的患者比其他两组患者更频繁地出现自发除颤（p < 0.02），术后更频繁地接受硝普钠治疗（p < 0.05）。从这些结果我们得出结论，血液停搏液在心肌缺血期间提供了出色的保护，可能优于所测试的两种晶体溶液中的一种，但并不优于另一种晶体溶液。由于这三种溶液在几个方面彼此不同，因此无法就任何一种成分的疗效得出结论。
