Hayashida N, Isomura T, Sato T, Maruyama H, Higashi T, Arinaga K, Aoyagi S
Second Department of Surgery, Kurume University, Fukuoka, Japan.
Ann Thorac Surg. 1998 Mar;65(3):615-21. doi: 10.1016/s0003-4975(97)01344-1.
To evaluate the effects of minimally diluted tepid blood cardioplegia, a prospective, randomized study was undertaken.
Thirty-seven patients undergoing isolated primary coronary artery bypass grafting were randomized to receive standard 4:1 diluted tepid blood cardioplegia (4:1 group, n = 18) or minimally diluted tepid blood cardioplegia (Mini group, n = 19). Cardioplegic solution was delivered in an intermittent antegrade fashion in both groups. Myocardial oxygen and lactate metabolism, release of the MB isoenzyme of creatine kinase and thiobarbituric acid reactive substances, and cardiac function were measured during and after the operation.
Myocardial oxygen consumption was significantly greater and lactate release was significantly lower in the Mini group than in the 4:1 group during cardioplegia. Minimally diluted blood cardioplegia resulted in more prompt resumption of lactate extraction, lower levels of release of the myocardial-specific isoenzyme of creatine kinase and thiobarbituric acid reactive substances during reperfusion, and better postoperative left ventricular function compared with the standard 4:1 cardioplegia.
Minimally diluted tepid blood cardioplegia may provide superior myocardial protection than the standard 4:1 dilution technique by optimizing the aerobic environment through an increase in oxygen supply during intermittent cardioplegia.
为评估微稀释温血心脏停搏液的效果，开展了一项前瞻性随机研究。
37例接受单纯初次冠状动脉旁路移植术的患者被随机分为两组，分别接受标准4:1稀释温血心脏停搏液（4:1组，n = 18）或微稀释温血心脏停搏液（微稀释组，n = 19）。两组均采用间歇性顺行灌注心脏停搏液。在手术期间及术后测量心肌氧和乳酸代谢、肌酸激酶MB同工酶及硫代巴比妥酸反应物质的释放情况以及心功能。
在心脏停搏期间，微稀释组的心肌氧消耗显著高于4:1组，而乳酸释放显著低于4:1组。与标准4:1心脏停搏液相比，微稀释温血心脏停搏液可使乳酸摄取恢复更快，再灌注期间心肌特异性肌酸激酶同工酶及硫代巴比妥酸反应物质的释放水平更低，术后左心室功能更好。
微稀释温血心脏停搏液通过在间歇性心脏停搏期间增加氧供应来优化有氧环境，可能比标准4:1稀释技术提供更好的心肌保护。
