Hayashida N, Ikonomidis J S, Weisel R D, Shirai T, Ivanov J, Carson S, Mohabeer M K, Tumiati L C, Mickle D A
Department of Clinical Biochemistry, Toronto Hospital, Ontario, Canada.
J Thorac Cardiovasc Surg. 1995 Sep;110(3):800-12. doi: 10.1016/S0022-5223(95)70114-1.
Seventy-five patients undergoing coronary artery bypass grafting were randomized to receive warm antegrade (N = 25), warm retrograde (N = 25), or a combination of warm antegrade and retrograde (N = 25) delivery of blood cardioplegic solution. Myocardial oxygen utilization, lactate and acid metabolism, and adenine nucleotides and their degradation products were measured during the operation and cardiac function was assessed postoperatively. Warm retrograde delivery of cardioplegic solution increased lactate and acid release during cardioplegia and reperfusion, decreased left ventricular adenosine triphosphate concentrations, and reduced the washout of adenine nucleotide degradation products from both left and right ventricles. Warm antegrade delivery of cardioplegic solution resulted in less lactate and acid release during cardioplegia but more lactate accumulated in the territory of the left anterior descending artery during the crossclamp period. Intermittent antegrade delivery of the cardioplegic solution during combination cardioplegia washed out lactate and acid, which suggested inhomogeneous delivery of the cardioplegic solution during continuous retrograde cardioplegia. Combination cardioplegia best preserved adenosine triphosphate in the left ventricle and resulted in the best postoperative left and right ventricular function. A combination of intermittent antegrade and continuous retrograde delivery of cardioplegic solution provided better myocardial protection than either antegrade or retrograde delivery of cardioplegic solution alone.
75例行冠状动脉搭桥术的患者被随机分为三组，分别接受顺行温血（N = 25）、逆行温血（N = 25）或顺行与逆行温血联合（N = 25）灌注心脏停搏液。术中测量心肌氧利用、乳酸和酸代谢以及腺嘌呤核苷酸及其降解产物，并在术后评估心功能。逆行温血灌注心脏停搏液在心脏停搏和再灌注期间增加了乳酸和酸的释放，降低了左心室三磷酸腺苷浓度，并减少了左右心室腺嘌呤核苷酸降解产物的清除。顺行温血灌注心脏停搏液在心脏停搏期间导致较少的乳酸和酸释放，但在夹闭期间左前降支区域积累了更多的乳酸。联合心脏停搏期间间歇性顺行灌注心脏停搏液清除了乳酸和酸，这表明持续逆行心脏停搏期间心脏停搏液的灌注不均匀。联合心脏停搏能最好地保存左心室中的三磷酸腺苷，并导致最佳的术后左右心室功能。间歇性顺行和持续逆行联合灌注心脏停搏液比单独顺行或逆行灌注心脏停搏液提供了更好的心肌保护。
