Massie M T, Darrell J C, DiMarco R F, Marrangoni A G, Wei L M, Miller S, Woelfel G F, Pellegrini R V
Department of Surgery, Mercy Heart Institute, Mercy Hospital of Pittsburgh, PA 15219.
Tex Heart Inst J. 1993;20(2):89-93.
Normothermic retrograde continuous cardioplegia is a revolutionary development for myocardial preservation in cardiac surgery. Despite excellent reports regarding this technique, the surgical community has expressed concern over technical problems encountered. The method of normothermic retrograde continuous cardioplegia in current use requires both large total crystalloid volumes and large potassium loads to deliver adequate cardioplegia. We have developed a technique that eliminates these problems. The heart is stopped by an initial infusion of normothermic cardioplegic solution through a coronary sinus catheter. The infusate is then converted to normothermic pump blood. Small boluses of potassium chloride are added intermittently to maintain cardiac arrest. We applied this technique to 35 patients undergoing cardiac valve surgery. The average volume of crystalloid cardioplegia required was 125 mL (range, 40 to 155 mL), and the average total potassium load was 52 mEq (range, 2 to 100 mEq). Clinically significant sequelae were noted in 4 patients (11%), and 1 (3%) died of pneumonia on the 28th postoperative day. The method we describe is a safe and effective alternative to the current technique of normothermic retrograde continuous cardioplegia and offers both physiologic and technical advantages to patients undergoing cardiac valve procedures.
常温逆行持续心脏停搏液灌注是心脏手术中心肌保护的一项革命性进展。尽管关于该技术有出色的报道，但外科界对所遇到的技术问题表示担忧。目前使用的常温逆行持续心脏停搏液灌注方法需要大量的晶体液总量和大量的钾负荷才能提供足够的心脏停搏液。我们开发了一种消除这些问题的技术。通过冠状窦导管首次输注常温心脏停搏液使心脏停跳。然后将灌注液转换为常温泵血。间歇性添加小剂量氯化钾以维持心脏停搏。我们将该技术应用于35例接受心脏瓣膜手术的患者。所需晶体心脏停搏液的平均量为125 mL（范围为40至155 mL），平均总钾负荷为52 mEq（范围为2至100 mEq）。4例患者（11%）出现具有临床意义的后遗症，1例（3%）在术后第28天死于肺炎。我们所描述的方法是当前常温逆行持续心脏停搏液灌注技术的一种安全有效的替代方法，为接受心脏瓣膜手术的患者提供了生理和技术上的优势。
