Louagie Y A, Gonzalez E, Jamart J, Malhomme B, Broka S, Buche M, Eucher P M, Schoevaerdts J C
Unit of Cardiovascular, Surgery, University Hospital of Mont-Godinne (Catholic University of Louvain), Mont-Yvoir, Belgium.
Ann Thorac Surg. 1997 Mar;63(3):689-96. doi: 10.1016/s0003-4975(96)01149-6.
A method of cold blood cardioplegia (CBCP) delivered continuously and in a retrograde manner was compared with methods differing only by their rate (intermittent) or way (antegrade) of administration.
This study comprises 298 consecutive patients undergoing isolated coronary artery bypass grafting procedures performed by the same surgeon from 1992 to 1995. Three-vessel disease characterized 58.8% of the cases, and the left ventricular ejection fraction was less than 0.40 in 22.8%. In group I (n = 100), CBCP was administered in an antegrade and intermittent fashion; in group II (n = 87), CBCP was given in a retrograde and intermittent manner; in group III (n = 111), CBCP delivery was retrograde and continuous.
The incidence of major cardiac adverse outcome (death or need for intraaortic balloon counterpulsation) was 7.0% in group I, 8.0% in group II, and 0.9% in group III (p = 0.040). Repeated-measures analysis of hemodynamic indices showed a marked superiority of continuous retrograde compared with antegrade intermittent blood cardioplegia regarding left ventricular stroke work index (p < 10(-4)) and compared with both methods of intermittent CBCP regarding right ventricular stroke work index (p < 10(-5)).
The use of continuous CBCP resulted in a significant reduction in major cardiac events, better left ventricular performance, and a marked improvement of right ventricular function in comparison with similar solutions of blood cardioplegia administered intermittently, independent of their way of delivery.
将持续逆行冷血心脏停搏（CBCP）方法与仅在给药速率（间歇性）或方式（顺行）上不同的方法进行比较。
本研究纳入了1992年至1995年间由同一位外科医生连续进行的298例孤立冠状动脉旁路移植手术患者。58.8%的病例为三支血管病变，22.8%的患者左心室射血分数低于0.40。在第一组（n = 100）中，CBCP以顺行和间歇性方式给药；在第二组（n = 87）中，CBCP以逆行和间歇性方式给药；在第三组（n = 111）中，CBCP给药为逆行且持续。
第一组主要心脏不良结局（死亡或需要主动脉内球囊反搏）的发生率为7.0%，第二组为8.0%，第三组为0.9%（p = 0.040）。血流动力学指标的重复测量分析显示，与顺行间歇性心脏停搏相比，持续逆行心脏停搏在左心室每搏功指数方面具有显著优势（p < 10⁻⁴），与两种间歇性CBCP方法相比，在右心室每搏功指数方面也具有显著优势（p < 10⁻⁵）。
与间歇性给予的类似心脏停搏液相比，使用持续CBCP可显著减少主要心脏事件，改善左心室功能，并显著提高右心室功能，且与给药方式无关。
