Talwalkar N G, Lawrie G M, Earle N, DeBakey M E
Division of Cardiothoracic Surgery, Baylor College of Medicine, Methodist Hospital, Houston, TX 77030, USA.
Chest. 1999 Jan;115(1):135-9. doi: 10.1378/chest.115.1.135.
When aortic insufficiency is present, antegrade delivery of cardioplegia requires coronary cannulation. Use of retrograde cardioplegia simplifies administration. The efficacy of the retrograde route alone in ensuring adequate myocardial protection may be assessed by the clinical outcome.
We used closed transatrial coronary sinus perfusion as the sole method of cardioplegia delivery in 100 patients who underwent valve operations, either isolated or combined with coronary (n=24), ascending aortic aneurysm (n=8), or other procedures. Eighty-one patients were in New York Heart Association (NYHA) Class III or IV; 23 had undergone previous heart operations; 23 were admitted from the coronary care unit (CCU); and 20 had left ventricular ejection fraction (LVEF) of < or = 40%. Operative mortality was 2%. An intra-aortic balloon pump was required in eight patients. On univariate analysis, perioperative use of inotropes (n=26) was related to age > or = 70 years (p=0.02), COPD (p=0.05), pulmonary hypertension (p=0.005), higher NYHA Class (p=0.0006), preoperative heart failure (p=0.006), lower LVEF (p=0.0003), urgency (p=0.00001), admission from the CCU (p=0.006), repeat operation (p=0.03), coronary artery disease (p=0.02), and longer ischemic (p=0.02) and bypass times (p=0.0003). On multivariate stepwise logistic regression analysis, use of inotropes was related to preoperative lower LVEF (p=0.02) and urgency of operation (p=0.0002). Perioperative complications included ventricular arrhythmia in six, heart block in one, renal dysfunction in nine, and stroke in two patients; no patient had myocardial infarction.
Good clinical results can be obtained by using retrograde cardioplegia alone without prior doses of antegrade cardioplegia in all valve operations.
存在主动脉瓣关闭不全时，顺行灌注心脏停搏液需要进行冠状动脉插管。逆行灌注心脏停搏液简化了给药过程。仅通过逆行途径确保充分心肌保护的有效性可通过临床结果进行评估。
我们将经心房封闭冠状动脉窦灌注作为100例接受瓣膜手术患者（单独或联合冠状动脉手术（n = 24）、升主动脉瘤手术（n = 8）或其他手术）唯一的心脏停搏液给药方法。81例患者为纽约心脏协会（NYHA）Ⅲ级或Ⅳ级；23例曾接受过心脏手术；23例从冠心病监护病房（CCU）收治；20例左心室射血分数（LVEF）≤40%。手术死亡率为2%。8例患者需要使用主动脉内球囊反搏。单因素分析显示，围手术期使用正性肌力药物（n = 26）与年龄≥70岁（p = 0.02）、慢性阻塞性肺疾病（COPD）（p = 0.05）、肺动脉高压（p = 0.005）、NYHA分级较高（p = 0.0006）、术前心力衰竭（p = 0.006）、较低的LVEF（p = 0.0003）、急诊手术（p = 0.00001）、从CCU收治（p = 0.006）、再次手术（p = 0.03）、冠状动脉疾病（p = 0.02）以及较长的缺血时间（p = 0.02）和体外循环时间（p = 0.0003）有关。多因素逐步逻辑回归分析显示，使用正性肌力药物与术前较低的LVEF（p = 0.02）和手术急诊情况（p = 0.0002）有关。围手术期并发症包括6例室性心律失常、1例心脏传导阻滞、9例肾功能不全和2例中风；无患者发生心肌梗死。
在所有瓣膜手术中，仅使用逆行心脏停搏液而不预先给予顺行心脏停搏液剂量可获得良好的临床结果。
