Boening A, Sanuri M, Buchwald D, Laczkovics A M
Department of Cardiothoracic Surgery, University of Bochum, Germany.
J Heart Valve Dis. 1996 May;5(3):273-80.
To determine whether warm blood cardioplegia (BCP) is superior to cold BCP in terms of myocardial protection, we compared warm (37 degrees C) and cold (4 degrees C) continuous retrograde administration of BCP in 40 patients undergoing aortic valve replacement (AVR) in a prospective, randomized study.
The main subjects of investigation were the myocardial oxygen consumption and the maintenance of the ultrastructure of the tissue. In addition, we looked at intraoperative recordings of time, heart rhythm disturbances, CK/MB serum levels, and inotropic support.
We found, that oxygen consumption is significantly higher during warm BCP (7.95-10.38 ml/min) than during cold BCP (2.11-3.47 ml/min). Mild, reversible myocardial damage occurs during cold and warm BCP. The intraoperative serum potassium level was significantly higher after warm (7.25 mmol/l) than after cold (6.55 mmol/l) BCP. There was no statistically significant difference in the duration of extracorporeal circulation and of cardiac arrest, the CK/MB serum level or the recorded right and left ventricular performance data in the two groups.
We conclude that continuous retrograde warm BCP is not superior to continuous retrograde cold BCP as far as myocardial protection is concerned. The administration of cold BCP prolongs the tolerated ischemic time of the myocardium and provides a higher safety margin.
为了确定温血心脏停搏液（BCP）在心肌保护方面是否优于冷血心脏停搏液，我们在前瞻性随机研究中，对40例行主动脉瓣置换术（AVR）的患者比较了温（37℃）冷血心脏停搏液的持续逆行灌注。
主要研究对象为心肌耗氧量和组织超微结构的维持。此外，我们还观察了术中时间记录、心律失常、血清肌酸激酶同工酶（CK/MB）水平及正性肌力支持情况。
我们发现，温血心脏停搏液灌注期间的耗氧量（7.95 - 10.38毫升/分钟）显著高于冷血心脏停搏液灌注期间（2.11 - 3.47毫升/分钟）。冷、温血心脏停搏液灌注期间均出现轻度、可逆性心肌损伤。温血心脏停搏液灌注后术中血清钾水平（7.25毫摩尔/升）显著高于冷血心脏停搏液灌注后（6.55毫摩尔/升）。两组体外循环和心脏停搏持续时间、血清CK/MB水平或记录的左右心室功能数据无统计学显著差异。
我们得出结论，就心肌保护而言，持续逆行温血心脏停搏液并不优于持续逆行冷血心脏停搏液。冷血心脏停搏液的灌注延长了心肌耐受缺血时间，并提供了更高的安全边际。
