Martella A T, Hoffman D M, Nakao T, Frater R W
Department of Cardiothoracic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
J Heart Valve Dis. 1994 Jul;3(4):404-9.
We have studied warm heart surgery, deemed as continuous warm blood cardioplegia and normothermic cardiopulmonary bypass (CPB), as an alternative to the technique of intermittent cold cardioplegia for valvular surgery. Between August 1990 and January 1994, 137 consecutive patients underwent valve repair or replacement using normothermic CPB. Eighty-six of these patients received continuous normothermic retrograde blood cardioplegia via the coronary sinus (CNRC). Fifty-one patients received intermittent cold blood cardioplegia (ICBC). All procedures were performed by the same surgeon (RWMF). The two groups were matched for age, sex, NYHA class, preoperative ejection fraction, diagnosis, procedure and activated clotting time. Warm blood cardioplegia was delivered continuously via the coronary sinus after antegrade arrest (oxygenated blood 1:4 to 1:3, 37 degrees C, 250-300 ml/min, maintaining coronary sinus pressures of 40-60 mmHg. Perioperative myocardial infarction was significantly less prevalent (4.6 vs. 8.0%; p < 0.05) in the warm cardioplegia group. Cardiac output immediately after bypass was significantly higher than before bypass only in the CNRC group (4.1 +/- 0.8 to 5.2 +/- 0.9 L/min; p < 0.01). CNRC patients had significantly higher incidence of spontaneous resumption of sinus rhythm at cross-clamp removal (80 of 86, 93%) compared to the hypothermic patients (14 of 51, 27%, p < 0.001). The time from removal of the aortic cross-clamp to discontinuation of CPB (reperfusion time) was significantly shorter in the warm cardioplegia group (43 +/- 7.4 versus 75 +/- 10.2 min; p < 0.001.(ABSTRACT TRUNCATED AT 250 WORDS)
我们研究了被视为持续温血心脏停搏和常温体外循环（CPB）的温心手术，将其作为瓣膜手术中间歇性冷心脏停搏技术的替代方法。在1990年8月至1994年1月期间，137例连续患者接受了使用常温CPB的瓣膜修复或置换术。其中86例患者通过冠状窦接受持续常温逆行血液心脏停搏（CNRC）。51例患者接受间歇性冷血心脏停搏（ICBC）。所有手术均由同一位外科医生（RWMF）进行。两组在年龄、性别、纽约心脏协会（NYHA）分级、术前射血分数、诊断、手术和活化凝血时间方面进行了匹配。在顺行停搏后，通过冠状窦持续输送温血心脏停搏液（氧合血1:4至1:3，37摄氏度，250 - 300毫升/分钟，维持冠状窦压力40 - 60毫米汞柱）。温心脏停搏组围手术期心肌梗死的发生率显著较低（4.6%对8.0%；p < 0.05）。仅在CNRC组中，体外循环后立即的心输出量显著高于体外循环前（4.1±0.8至5.2±0.9升/分钟；p < 0.01）。与低温患者相比，CNRC患者在松开主动脉夹时窦性心律自发恢复的发生率显著更高（86例中的80例，93%对51例中的14例，27%，p < 0.001）。温心脏停搏组从松开主动脉夹到停止CPB的时间（再灌注时间）显著更短（43±7.4对vs 75±10.2分钟；p < 0.001）。（摘要截断于250字）
