Pehkonen E J, Honkonen E L, Mäkynen P J, Kataja M J, Tarkka M R
Department of Thoracic and Cardiovascular Surgery, Tampere University Hospital, Finland.
Scand J Thorac Cardiovasc Surg. 1996;30(3-4):149-55. doi: 10.3109/14017439609107260.
One-hundred and nine patients undergoing coronary artery bypass grafting were randomized to seven groups according to cardioplegia technique (5 types) and right coronary patho-anatomy (2 types). There were no major intergroup differences in postoperative outcome. Conduction disturbances developed in 26 patients, also without intergroup difference. Factors predictive of conduction disturbances were studied by univariate and multivariate analyses. Patients with such disturbances had lower myocardial temperatures than the others and more often postoperative atrial fibrillation (10/26 vs 15/83, p < 0.05). Comparison of this case series with a prospective study from our hospital in 1988-1989 showed that myocardial protection was superior in the present study. The incidence of right bundle branch block was similar in the two studies (24% vs 23%), but that of left-side conduction disturbances (bundle branch or fascicular block) was dramatically reduced (19% vs 1%, p < 0.0001) concomitantly with improved myocardial protection, indicating that development of a left-side conduction disturbance is associated with myocardial injury.
109例行冠状动脉旁路移植术的患者根据心脏停搏技术（5种类型）和右冠状动脉病理解剖（2种类型）被随机分为7组。术后结果在组间无重大差异。26例患者出现传导障碍，组间也无差异。通过单因素和多因素分析研究了传导障碍的预测因素。出现此类障碍的患者心肌温度低于其他患者，且术后房颤更常见（10/26 vs 15/83，p<0.05）。将该病例系列与我院1988 - 1989年的一项前瞻性研究进行比较，结果显示本研究中的心肌保护更优。两项研究中右束支传导阻滞的发生率相似（24% vs 23%），但随着心肌保护的改善，左侧传导障碍（束支或分支阻滞）的发生率显著降低（19% vs 1%，p<0.0001），表明左侧传导障碍的发生与心肌损伤有关。
