多剂量晶体液与冷血钾停搏液在冠状动脉旁路移植手术中相对有效性的临床评估：一项非随机配对分析

Clinical evaluation of the relative effectiveness of multidose crystalloid and cold blood potassium cardioplegia in coronary artery bypass graft surgery: a nonrandomized matched-pair analysis.

作者信息

Roberts A J, Moran J M, Sanders J H, Spies S M, Lichtenthal P R, Kaplan K J, Michaelis L L

出版信息

Ann Thorac Surg. 1982 May;33(5):421-33. doi: 10.1016/s0003-4975(10)60780-1.

Abstract

Controversy exists concerning the most effective method of myocardial protection during coronary artery bypass graft operations. Accordingly, we performed a matched-pair analysis between 25 patients receiving multidose hypothermic potassium crystalloid cardioplegia and 25 other patients receiving cold blood potassium cardioplegia. Patients were matched on the basis of preoperative ejection fraction (EF) and the number of anatomically similar stenotic coronary arteries. The adequacy of myocardial protection was assessed by serial perioperative determinations of radionuclide ventriculography, hemodynamic measurements, analyses of electrocardiograms and serum levels of MB-CK. We found that the level of myocardial protection was similar between unstratified groups. However, when subgroups were selected on the basis of prolonged aortic cross-clamp time (greater than ninety minutes) or impaired preoperative left ventricular function (EF less than 40%), there was a suggestion that cold blood cardioplegia may be advantageous.

摘要

关于冠状动脉搭桥手术中最有效的心肌保护方法存在争议。因此，我们对25例接受多剂量低温钾晶体心脏停搏液的患者和另外25例接受冷血钾心脏停搏液的患者进行了配对分析。患者根据术前射血分数（EF）和解剖学上相似的狭窄冠状动脉数量进行配对。通过围手术期连续测定放射性核素心室造影、血流动力学测量、心电图分析和MB-CK血清水平来评估心肌保护的充分性。我们发现未分层组之间的心肌保护水平相似。然而，当根据主动脉交叉钳夹时间延长（大于90分钟）或术前左心室功能受损（EF小于40%）选择亚组时，提示冷血心脏停搏液可能更具优势。