Yuan S M
Department of Cardiovascular Surgery, Great Wall Hospital, Beijing, People Republic of China.
Kaohsiung J Med Sci. 1998 Oct;14(10):616-24.
The purpose of this paper was to assess the role of continuous warm blood cardioplegia in heart valve replacement in comparison with standard intermittent cold crystalloid cardioplegia. Twenty patients undergoing open heart valve replacement were divided arbitrarily into two groups in this study; Group I was given intermittent perfusion of cold crystalloid (St. Thomas Hospital solution) with hypothermic cardiopulmonary bypass (CPB) (10 patients) and Group II was given continuous administration of warm blood cardioplegia with normothermic CPB (10 patients). The groups were similar with respect to sex, age, body surface area and preoperative ventricular function. Bypass conditions as well as perioperative complications were evaluated in the respective groups. Peak values of the serum enzyme levels within 120 hours of postoperation including alanine transaminase, aspartate aminotransferase, lactate dehydrogenase (LDH) and its isoenzymes LDH1 + LDH2, phosphokinase (CK) and its isoenzyme CK-MB, superoxide dismutase, and malondialdehyde in the two groups were also assessed. Biopsies from the right atrium were obtained immediately before aortic cross clamp removal (ischemic period), and 30 minutes after cross clamp removal (reperfusion period). Myocardial structures were observed and scored. No significant intergroup differences were found in the bypass conditions except for the perfusion flow, systemic temperature and central venous pressure. There were no significant differences in the intergroup perioperative complications, either. Serum enzymes except CK which reached peak values in Group I appeared prior to or consistent with Group II. There were no significant intergroup differences in peak levels of the serum enzymes except CK (307.44 +/- 38.56 U/L vs. 466.29 +/- 52.03 U/L, p = 0.039 for CK). From the pathological assessment, the structural alterations were the most severe during the reperfusion period in group I. Myocardial damage showed more severely in reperfusion than in ischemia in both. Warm blood cardioplegic technique, raising potential hazards, is still a practical method for myocardial protection in open heart surgery, but might be less effective in protecting the tissues beyond myocardium.
本文旨在评估持续温血心脏停搏液与标准间歇性冷晶体心脏停搏液相比，在心脏瓣膜置换术中的作用。本研究将20例行心脏瓣膜置换术的患者随机分为两组；第一组在低温体外循环（CPB）下给予间歇性冷晶体灌注（圣托马斯医院溶液）（10例患者），第二组在常温CPB下给予持续温血心脏停搏液（10例患者）。两组在性别、年龄、体表面积和术前心室功能方面相似。对各组的体外循环情况及围手术期并发症进行评估。还评估了两组术后120小时内血清酶水平的峰值，包括丙氨酸转氨酶、天冬氨酸转氨酶、乳酸脱氢酶（LDH）及其同工酶LDH1 + LDH2、磷酸激酶（CK）及其同工酶CK-MB、超氧化物歧化酶和丙二醛。在主动脉阻断钳移除前（缺血期）和移除后30分钟（再灌注期）立即获取右心房活检组织。观察心肌结构并进行评分。除灌注流量、体循环温度和中心静脉压外，两组体外循环情况无显著组间差异。组间围手术期并发症也无显著差异。除CK外，第一组血清酶峰值出现时间早于或与第二组一致，CK在第一组达到峰值。除CK外，两组血清酶峰值水平无显著组间差异（CK为307.44 +/- 38.56 U/L vs. 466.29 +/- 52.03 U/L，p = 0.039）。从病理评估来看，第一组再灌注期结构改变最为严重。两组心肌损伤在再灌注期均比缺血期更严重。温血心脏停搏技术虽存在潜在风险，但仍是心脏直视手术中一种实用的心肌保护方法，不过在保护心肌以外的组织方面可能效果较差。
