Moizumi Y, Ohsaka K, Akasaka J, Kondoh S, Shimizu M, Imai Y, Kumagai T, Uchiyama T, Abe Y, Suzuki I
Department of Thoracic and Cardiovascular Surgery, Sendai City Medical Center, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Feb;42(2):198-205.
We evaluated the advantages of combined antegrade and retrograde GIK cardioplegia in 65 patients undergoing CABG. Thirty seven patients were administered antegrade cardioplegia (Group A), whereas 28 patients were administered combined antegrade and retrograde cardioplegia (Group C). Enzyme release and hemodynamic data were obtained before the onset of CPB and at 1, 3, 6, 9, 12 and 24 hours after operation. Both groups were similar in age and incidence of diabetes, previous MI, PTCA, severity of coronary artery disease and emergent operation. In group A, antegrade cardioplegia produced poor anterior septal cooling in 17 patients (45%). To ensure adequate myocardial protection in these cases 9, patients were anastomosed saphenous vein graft first to LAD instead of IMA and perfused cardioplegic solution through the grafts. In group C, although adequate anterior septal cooling also could not be obtained with antegrade cardioplegia in 16 patients (57%), after retrograde cardioplegia, anterior septal temperature fell below 10 degrees C. The use of IMA graft was more practiced in group C. (79% in group C versus 32% in group A, p < 0.05) Enzyme release (CPK-MB, %CPK-MB, LDH) and hemodynamic data (CI, LVSWI, RVSWI, RVEF, RVEDVI) were similar in both group. Furthermore, no significant difference were noted in the incidence of post-operative LOS, PMI and ventricular arrhythmia. We concluded that the use of combined antegrade and retrograde cardioplegia is more effective than antegrade cardioplegia, because of adequate anterior septal cooling, and it will allow patients with severe and extent coronary artery disease to undergo safe IMA grafting.
我们评估了65例行冠状动脉旁路移植术（CABG）患者采用顺行和逆行联合极化液心脏停搏的优势。37例患者接受顺行心脏停搏（A组），而28例患者接受顺行和逆行联合心脏停搏（C组）。在体外循环开始前以及术后1、3、6、9、12和24小时获取酶释放和血流动力学数据。两组在年龄、糖尿病发病率、既往心肌梗死、经皮冠状动脉腔内血管成形术（PTCA）、冠状动脉疾病严重程度及急诊手术方面相似。在A组，17例患者（45%）顺行心脏停搏时前间隔冷却效果不佳。为确保这些病例心肌得到充分保护，9例患者首先将大隐静脉移植至左前降支而非内乳动脉，并通过移植血管灌注心脏停搏液。在C组，尽管16例患者（57%）顺行心脏停搏时前间隔冷却也不充分，但逆行心脏停搏后，前间隔温度降至10℃以下。C组更多使用内乳动脉移植（C组为79%，A组为32%，p<0.05）。两组的酶释放（肌酸磷酸激酶同工酶MB、肌酸磷酸激酶同工酶MB百分比、乳酸脱氢酶）和血流动力学数据（心脏指数、左心室每搏功指数、右心室每搏功指数、右心室射血分数、右心室舒张末期容积指数）相似。此外，术后住院时间、心肌梗死和室性心律失常的发生率无显著差异。我们得出结论，顺行和逆行联合心脏停搏比顺行心脏停搏更有效，因为其前间隔冷却充分，且能使冠状动脉疾病严重且广泛的患者安全地进行内乳动脉移植。
