Menasché P, Fleury J P, Veyssié L, Le Dref O, Touchot B, Piwnica A H, Bloch G
Department of Cardiovascular Surgery, Hôpital Lariboisière, Paris, France.
Ann Thorac Surg. 1993 Nov;56(5):1148-53. doi: 10.1016/0003-4975(95)90033-0.
Peripheral vasodilation is commonly seen during and after warm heart operations and can become of clinical concern when it requires vasopressors because some of these drugs adversely affect coronary artery bypass graft flows. As hemodilution lowers systemic vascular resistance, we assessed whether peripheral vasodilation could be limited by a drastic reduction of the volume of infused cardioplegia. Fifty patients underwent isolated coronary artery bypass grafting procedures using normothermic (35 degrees to 37 degrees C) bypass and normothermic continuous retrograde blood cardioplegia. They were divided into two equal groups: in group 1, blood was diluted 4:1 with hyperkalemic crystalloid cardioplegia, whereas in group 2, the cardioplegic "solution" was limited to the sole arresting agents that were concentrated in a small volume (16 mEq potassium chloride and 3 mEq magnesium chloride in a 20-mL ampoule). This "mini-cardioplegia" was continuously added to arterial blood so as to keep the heart arrested. The average volume of cardioplegia per patient was 1,000 mL in group 1 and 58 mL in group 2 (p < 0.0001). The mini-cardioplegia technique resulted in a reduced incidence of perioperative systemic vasodilation: group 2 patients required significantly less vasopressors (p < 0.05) and less volume loading, as reflected by significantly lower right atrial and pulmonary capillary wedge pressures (p < 0.05 and p < 0.03 at 12 hours postoperatively, respectively), compared with group 1 patients who received traditional high-volume cardioplegia. There were no differences between the two groups with respect to myocardial recovery, as assessed by standard clinical and hemodynamic end points.(ABSTRACT TRUNCATED AT 250 WORDS)
在心脏体外循环手术期间及术后，外周血管扩张较为常见。当需要使用血管升压药时，这可能会引起临床关注，因为其中一些药物会对冠状动脉搭桥移植术的血流产生不利影响。由于血液稀释会降低体循环血管阻力，我们评估了大幅减少心脏停搏液输注量是否能限制外周血管扩张。50例患者接受了常温（35至37摄氏度）体外循环下的单纯冠状动脉搭桥手术，并采用常温持续逆行血液心脏停搏法。他们被平均分为两组：在第1组中，用高钾晶体心脏停搏液将血液稀释为4:1；而在第2组中，心脏停搏“溶液”仅限于集中在小体积中的单一停搏剂（20毫升安瓿中含16毫当量氯化钾和3毫当量氯化镁）。这种“迷你心脏停搏液”持续添加到动脉血中以维持心脏停搏。第1组患者每位平均心脏停搏液量为1000毫升，第2组为58毫升（p<0.0001）。迷你心脏停搏液技术降低了围手术期全身血管扩张的发生率：与接受传统大容量心脏停搏液的第1组患者相比，第2组患者所需血管升压药显著减少（p<0.05），容量负荷也更小，这可通过术后12小时时显著更低的右心房和肺毛细血管楔压反映出来（分别为p<0.05和p<0.03）。根据标准临床和血流动力学终点评估，两组在心肌恢复方面没有差异。（摘要截短于250字）
