体外循环心脏停跳及不停跳下心内直视手术中心肌保护效果对比研.doc

体外循环心脏停跳及不停跳下心内直视手术中心肌保护效果对比研 　 作者：黄光梅，李聚禧，李泽均，吴勋宁，谭宁，周育华，雷春芳，梁妮 【摘要】 目的 探讨浅低温体外循环心脏不停跳下心内直视手术中对心肌的保护作用。方法 选择行心内直视手术患者50例，随机分为实验组(心脏不停跳法)和对照组(心脏停跳法)。两组分别在术前、停机即刻、术后6h、术后24h四个时点采静脉血测定磷酸肌酸激酶（CK）、磷酸肌酸激酶同工酶（CK-MB）、天门冬氨酸转移酶（AST）含量、心肌肌钙蛋白I（cTnI）含量。结果 两组CK、CK-MB、AST、cTnI转机后均升高，CK、CK-MB、AST停机即刻、术后6h，对照组高于实验组，24h逐渐恢复。对照组停机即刻至24h cTnI均高于实验组，两组高峰期均出现于术后6h，术后6～24h两组相比差异更明显(P＜0.01)。结论 不停跳手术对心肌具有更好的保护作用。 【关键词】 体外循环；心脏停搏，人工；心肌保护；心内直视手术 　　Myocardial protection： on-pump vs.off-pump intracardiac surgery 　　Abstract： Objective To investigate the myocardial protection in off-pump intracardiac surgery with mild hypothermia. Methods 50 patients undergoing intracardiac surgery were randomly divided into experiment group (on-pump surgery) and control group (off-pump surgery).In these two groups，serum creatine kinase (CK)，creatine kinase-MB (CK-MB)，aspartate aminotransferase (AST) and cardiac troponin I (cTnI) were assayed before surgery，immediate post operative period，6h after surgery and 24h after surgery. Results In these two groups，elevated CK，CK-MB，AST and cTnI were found at the beginning of extracorporeal circulation.Compared to the control group，the levels of serum CK，CK-MB and AST were higher at immediate post surgery，6h after surgery，and recovered gradually 24 hours later.In comparison to experiment group，serum cTnI was higher from immediate post surgery to 24 hours later，the peak period appeared in 6 hours after surgery，there was statistically significant difference from 6～24h after surgery between these two groups (P<0.01). Conclusion On-pump intracardiac surgery may result in better myocardial protection. 　　Key words： extracorporeal circulation; heart arrest，induced; cardiac protection; intracardiac surgery 　　心肌保护一直是心脏外科的焦点，近年来浅低温体外循环(CPB)不停跳心内直视手术取得了良好的效果，该术式被国内越来越多的单位采纳和推广应用，但其对心肌的保护作用尚有争议。现对体外循环心脏停跳与不停跳下心内直视手术中心肌保护效果作一对比研究，进而为心脏不停跳下心内直视手术临床应用提供客观的理论依据。 　　1 资料和方法 　　1.1 一般资料 选择自2002年1月～2006年2月行心内直视手术的患者50例，其中男22例，女28例，年龄4～75岁，体重10～65kg。病种：先心病38例，瓣膜病7例，心脏肿瘤5例。随机分为两组，实验组为心脏