Takeuchi K, Maida K, Yoshida S, Suzuki S, del Nido P J, Tanaka S
Department of Cardiovascular Surgery, Aomori General Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Oct;45(10):1715-9.
Blood cardioplegia has been widely accepted due to better oxygen delivery, pH buffering and free radical scavenge. We have found that a crystalloid cardioplegia solution formulated to accelerate anaerobic glycolysis with high buffering capacity. To conserve blood cardioplegia, we formulated a crystalloid cardiopletia containing 100 mM histidine for buffering. This cardioplegia (HBS) was compared to cold blood cardioplegia in patients requiring open heart surgery. Eighty patients including HBS (n = 28), and CBC (n = 40) were involved in this study. Left ventricular end-systolic elastance (Emax; mmHg/cm3) was evaluated pre- and postoperatively. Cardiac index and inotropic requirement were also monitored at 1, 3, and 12 hours after cardiopulmonary bypass. There was no death in either group. All hearts returned to previous rhythm in HBS group, whereas total 12 DC cardioversions were requested in 6 patients. Emax was significantly higher in HBS group (5.2 +/- 0.6 mmHg/cm3) than in CBC group (3.4 +/- 0.4 mmHg/cm3). Cardiac index was also significantly higher in HBS group postoperatively than in CBC group with lower inotropic requirements. We conclude that histidine containing crystalloid cardioplegia provides excellent recovery of cardiac performance with lower inotropic requirements in open heart surgery. The ease of use, and lack of blood are other important advantages of this crystalloid cardioplegia.
血液停搏液因其更好的氧输送、pH缓冲和自由基清除作用而被广泛接受。我们发现一种配制的晶体停搏液，可加速无氧糖酵解并具有高缓冲能力。为了节省血液停搏液，我们配制了一种含100 mM组氨酸用于缓冲的晶体心脏停搏液。将这种停搏液（HBS）与需要心脏直视手术患者的冷血停搏液进行比较。本研究纳入了80例患者，包括HBS组（n = 28）和CBC组（n = 40）。术前和术后评估左心室收缩末期弹性（Emax；mmHg/cm³）。在体外循环后1、3和12小时也监测心脏指数和强心药物需求。两组均无死亡。HBS组所有心脏均恢复至先前节律，而6例患者共需要12次直流电复律。HBS组的Emax（5.2±0.6 mmHg/cm³）显著高于CBC组（3.4±0.4 mmHg/cm³）。HBS组术后心脏指数也显著高于CBC组，且强心药物需求更低。我们得出结论，含组氨酸的晶体停搏液在心脏直视手术中能使心脏功能出色恢复，且强心药物需求更低。这种晶体停搏液使用方便且无需血液，还有其他重要优点。
