Ericsson A B, Takeshima S, Vaage J
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
J Thorac Cardiovasc Surg. 1998 Mar;115(3):716-22. doi: 10.1016/S0022-5223(98)70338-1.
Simultaneous delivery of antegrade and retrograde cardioplegia may provide a more homogeneous distribution of cardioplegic solution. It may, however, increase myocardial edema and postcardioplegic myocardial injury. The purpose of this study was to compare simultaneous antegrade-retrograde cardioplegia with antegrade cardioplegia.
After 30 minutes of warm, "unprotected," global ischemia, pigs were given warm, continuous blood cardioplegia for 45 minutes (antegrade group, n = 8 and simultaneous antegrade-retrograde group, n = 9). All pigs were weaned from cardiopulmonary bypass 45 to 60 minutes after aortic unclamping. Indices of left ventricular function were measured after another 30 minutes with the conductance catheter technique and pressure-volume loops.
Global left ventricular function, evaluated by preload recruitable stroke work, decreased from baseline values of 126 (102 to 150) (mean [90% confidence limits]) (antegrade) and 122 (116 to 127) erg/ml x 10(3) (simultaneous) to 75 (61 to 89) (p = 0.004) and 95 (79 to 112) erg/ml x 10(3) (p = 0.02), respectively. End-diastolic pressure-volume relation increased from 0.25 (0.21 to 0.28) (antegrade) and 0.30 (0.25 to 0.35) mm Hg/ml (simultaneous) to 0.60 (0.41 to 0.79) (p = 0.009) and 0.53 (0.35 to 0.71) mm Hg/ml (p = 0.02), respectively. The time constant of left ventricular pressure relaxation was unchanged. No intergroup difference was observed in preload recruitable stroke work, preload recruitable stroke work area, end-diastolic pressure volume relation, or stiffness constant. Plasma levels of troponin T increased without any difference between groups. Myocardial water content was increased in the simultaneous group (81.1% [80.7% to 81.5%]) versus the antegrade group (80.1% [79.6% to 80.7%], p = 0.01).
Despite a small increase in myocardial water content induced by simultaneous blood cardioplegia, no impairment of postcardioplegic cardiac function was observed compared with antegrade cardioplegia.
顺行和逆行心脏停搏液同时灌注可能会使心脏停搏液分布更均匀。然而，这可能会增加心肌水肿和心脏停搏后心肌损伤。本研究的目的是比较顺行 - 逆行联合心脏停搏与顺行心脏停搏。
在30分钟的温血“无保护”全心缺血后，给予猪45分钟的温血持续血液心脏停搏液灌注（顺行组，n = 8；顺行 - 逆行联合组，n = 9）。所有猪在主动脉阻断后45至60分钟脱离体外循环。在另外30分钟后，采用电导导管技术和压力 - 容积环测量左心室功能指标。
通过可招募前负荷每搏功评估的全心左心室功能，顺行组从基线值126（102至150）（均值[90%置信区间]）和联合组122（116至127）尔格/毫升×10³分别降至75（61至89）（p = 0.004）和95（79至112）尔格/毫升×10³（p = 0.02）。舒张末期压力 - 容积关系从0.25（0.21至0.28）（顺行）和0.30（0.25至0.35）毫米汞柱/毫升（联合）分别增至0.60（0.41至0.79）（p = 0.009）和0.53（0.35至0.71）毫米汞柱/毫升（p = 0.02）。左心室压力松弛时间常数未改变。在可招募前负荷每搏功、可招募前负荷每搏功面积、舒张末期压力 - 容积关系或硬度常数方面未观察到组间差异。肌钙蛋白T的血浆水平升高，两组间无差异。联合组的心肌含水量增加（81.1%[80.7%至81.5%]），而顺行组为80.1%[79.6%至80.7%]，p = 0.01。
尽管联合血液心脏停搏引起心肌含水量略有增加，但与顺行心脏停搏相比，未观察到心脏停搏后心脏功能受损。
