婴幼儿温-冷-温停博液灌注心肌临床探究.docVIP

婴幼儿温-冷-温停博液灌注心肌临床探究 　 作者：张鲁英，姜冠华，张广福，梁家立 【关键词】 温血诱导停搏 摘要：目的 观察32℃新鲜氧合血行温血诱导停搏和终末温血再灌注对心肌保护的影响。 方法 婴幼儿法洛四联症根治术64例，随机分为：温血组32例（温血诱导停搏后改用冷血灌注+终末温血灌注）；冷血组32例（冷晶体诱导停搏后改用冷血灌注）。分别观察主动脉开放后心脏复跳和最初心律。结果 温血组全部自动复跳；冷血组自动复跳率为71．88％（Plt;0.05），且最初心律失常率28．12％（Plt;0.05）。结论 温血诱导停搏和终末温血再灌注利于心肌保护。 　　关键词：温血诱导停搏;终末温血灌注;心肌保护;山莨菪碱 　　Clinical Study of Warm-Cold-Warm Perfusion on Myocardial Protection 　　Abstract: OBJECTIVETo study the effect of warm-blood induced cardiac arrest and end perfusion with 32°C fresh oxygenated blood ．METHODS 64 infants undergoing radical correction of Tetralogy of Fallot were randomly classified into 2 groups:warm group and cool group, with 32 infants in each group. In the warm group,cardiac arrest was induced with warm-blood cardioplegia,and then, the hearts were perfused with cool blood. Before removing the X-clamp, warm blood was again used for the last infusion.In the cool group,by contrast cold crystalloid cardioplegia was used to induce cardiac arrest with no and on final warm blood infusion. The incidence of defibrillation and occurrence of arrhythmia wsa recorded after off-clamps. RESULTS Defibrillation was not necessary in the warm group,and the incidence of defibrillation in the cool group was 28.12％（Plt;0.05）; In the warm group, all infants resumed their sinus rhythm, while the incidence of ventricular or supraventricular arrhythmia was 28.12％（Plt;0.05）in the cool group. CONCLUSION Warm-blood induced cardiac arrest with a final infusion of warm blood was advantageous for myocardial protection in cardiac surgery. 　　Key words：warm blood；cool blood；cardiac arrest; myocardial protection; anisodamine 　　婴幼儿复杂型心脏病由于病情重，手术时间长及心内回血多等特点，用常温体外循环影响术野清晰，而用冷血灌注可产生心脏冷挛缩等不利影响。我们用32 °C新鲜氧合血行温血诱导心脏停搏和终末温血灌注，以加强心肌保护，取得良好效果。 　　1 材料与方法 　　1.1 病例选择 　　本组共64例，年龄均3岁行法洛四联症根治术的婴幼儿。随机分为两组。温血组用温血诱导停搏后改为冷血灌注+终末温血灌注；冷血组用冷晶体诱导停搏后改为冷血灌注。一般临床资料见表１。表1 一般临床资料 （略）注：LVDEVI为超声心动图测定的左室舒张末期容量指数。 　　1.2 实验方法 　　温血组用的是“温-冷-温”方法。常规转流阻断升主动脉后，即用温血（32℃）高钾停搏液（稀释氧合血100ml，K+28mmol/L）诱导停搏，用量5~7ml/kg。心