Hayashida N, Ikonomidis J S, Weisel R D, Shirai T, Ivanov J, Carson S M, Mohabeer M K, Tumiati L C, Mickle D A
Department of Clinical Biochemistry, Toronto Hospital, Ontario, Canada.
Ann Thorac Surg. 1994 Oct;58(4):961-71. doi: 10.1016/0003-4975(94)90439-1.
Seventy-two patients undergoing coronary artery bypass grafting were randomized to receive cold (8 degrees C) antegrade or retrograde, tepid (29 degrees C) antegrade or retrograde, or warm (37 degrees C) antegrade or retrograde blood cardioplegia (n = 12 in each group). Myocardial oxygen utilization as well as lactate and acid metabolism were assessed intraoperatively and cardiac function was assessed postoperatively. Myocardial oxygen consumption and anaerobic lactate release were greatest during warm, intermediate during tepid, and least during cold cardioplegic arrest. Myocardial oxygen consumption and lactate release were underestimated during retrograde cardioplegia because of contamination of aortic root samples. Warm retrograde and tepid retrograde cardioplegia resulted in greater lactate and acid washout with reperfusion. Left ventricular stroke work indices were greater after warm antegrade and tepid antegrade cardioplegia than after cold antegrade cardioplegia, and right ventricular stroke work indices were greatest after warm antegrade cardioplegia. Warm antegrade cardioplegia increased aerobic metabolism during and after cardioplegia and preserved left and right ventricular function. Tepid antegrade cardioplegia reduced anaerobic lactate and acid release during arrest and preserved cardiac function.
72例行冠状动脉搭桥术的患者被随机分为接受冷（8摄氏度）顺行或逆行、温（29摄氏度）顺行或逆行、或暖（37摄氏度）顺行或逆行血液心脏停搏液治疗（每组n = 12）。术中评估心肌氧利用以及乳酸和酸代谢，术后评估心功能。心肌氧消耗以及无氧乳酸释放量在暖心脏停搏时最大，在温心脏停搏时居中，在冷心脏停搏时最小。由于主动脉根部样本受到污染，逆行心脏停搏期间心肌氧消耗和乳酸释放量被低估。温逆行和温逆行心脏停搏导致再灌注时乳酸和酸清除增加。与冷顺行心脏停搏后相比，温顺行和温顺行心脏停搏后左心室每搏功指数更高，而右心室每搏功指数在温顺行心脏停搏后最大。温顺行心脏停搏增加心脏停搏期间及之后的有氧代谢，并保留左、右心室功能。温顺行心脏停搏减少心脏停搏期间无氧乳酸和酸的释放，并保留心功能。
