Wandschneider W, Winter S, Thalmann M, Howanietz N, Deutsch M
Department of Cardiovascular and Vascular Surgery, General Hospital Lainz, Vienna, Austria.
J Cardiovasc Surg (Torino). 1994 Dec;35(6 Suppl 1):85-9.
In a prospective randomized trial we investigated the benefit of blood versus asanguinous cardioplegia in routine coronary by-pass grafting. One hundred consecutive adult patients were randomly assigned to two groups: Group A (53 patients) received cold blood cardioplegia and group B (47 patients) had standard St. Thomas solution. In all patients we combined ante- and retrograde administration, in group A warm reperfusion was carried out before aortic declamping. Aortic cross clamp times, amount of cardioplegic solution and blood potassium levels at the end of cardio-pulmonary by-pass were higher in group A than in group B. The need for inotropic support at the end of the operation as well as in the postoperative period was more frequent in the crystalloid cardioplegia group. The occurrence of atrial fibrillation showed no clear correlation to the kind of cardioplegia used. Perioperative infarction was less frequent in the blood cardioplegia group (3.7% vs 6.3%; p < 0.01) and 30-day-mortality was nil (0% vs 3.2%; p < 0.01). Hospital stay did not differ between the two groups. In this clinical trial we could demonstrate the superiority of blood versus crystalloid cardioplegia in routine coronary by-pass grafting. Ante- and retrograde delivery of cold blood cardioplegia followed by warm reperfusion is a safe and simple method yielding satisfactory results.
在一项前瞻性随机试验中，我们研究了在常规冠状动脉搭桥术中使用含血停搏液与无血停搏液的益处。连续100例成年患者被随机分为两组：A组（53例患者）接受冷血停搏液，B组（47例患者）使用标准圣托马斯溶液。所有患者均采用顺行和逆行给药相结合的方法，A组在主动脉阻断前进行温血再灌注。体外循环结束时，A组的主动脉阻断时间、停搏液用量和血钾水平均高于B组。晶体停搏液组在手术结束时及术后需要使用正性肌力药物支持的情况更为频繁。房颤的发生与所用停搏液的类型无明显相关性。含血停搏液组围手术期梗死发生率较低（3.7%对6.3%；p<0.01），30天死亡率为零（0%对3.2%；p<0.01）。两组的住院时间无差异。在这项临床试验中，我们证明了在常规冠状动脉搭桥术中含血停搏液优于晶体停搏液。冷血停搏液顺行和逆行给药后进行温血再灌注是一种安全、简单的方法，效果令人满意。
