心脏手术中单次灌注停搏液对心肌保护效果.docVIP

心脏手术中单次灌注停搏液对心肌保护效果 　 作者：冼艳冰，黄伟明，朱艳玲，杨广，荣健 【摘要】 目的 探讨在心肺转流（Cardiopulmonary Bypass，CPB）心脏手术中，应用单次灌注心脏停搏液方法对主动脉阻断时间超过60 min的心肌保护效果。方法 50例患者，先天性心脏病21例，后天性心脏病29例，采用4∶1血液晶体停搏液在主动脉根部或加冠状动脉顺行灌注，先温血后冷血灌注，灌注量15 ml/kg，术中不论主动脉阻断时间长短，只要心电图不出现活动波形，不再重复灌注。结果 全组患者CPB时间（118.66±29.98）min，主动脉阻断时间（78.3±18.0）min，均一次性灌注停搏液。开放主动脉后心脏自动复跳44例（88%），电击后复跳5例（10%），复跳后除颤1例（2%），全组患者无出现低心排综合征、心衰等并发症，全部康复出院。结论 单次灌注停搏液方法可使心肌得到良好的保护，心脏自动复跳率高，心功能恢复快，适用于不同病种的心脏手术。 【关键词】 心肺转流；停搏液灌注；心肌保护 　　Effects of Single Perfusion of Cardioplegia Fluid on Myocardial Preservation in Heart Surgery With Cardiopulmonary Bypass 　　Abstract: OBJECTIVE To evaluate the myocardial preservation with single dose perfusing of cardioplegic solution in intracardiac surgery under extracorporeal circulation in which the time of aortic clamping is more than 60 minutes.METHODS 50 patients were enrolled ,21 patients are suffered from congenital heart disense ,the others are acquired.In all patients 15ml/kg ,4∶1 blood-crystalloid cardioplegic solution were perfused anterograde at the root of aorta or/and coronary artery.Warm blood and cold blood were perfused in sequence. A single dose of cardioplegic solution were perfused except active wave form was present in electrocardiogram.RESULTS Time of CPB was（118.66±29.98）min，and time of aortic clamping was （78.3±18.0）min . All patients were perfused in a single dose of cardioplegic solution. When the aortic clamp has been removed the heart regains activity spontaneously in 44(88%) patients, by sideration in 5(10%)patients,by defibrillation in 1(2%)patient.There is no complications such as low output or heart failure. CONCLUSION Myocardial preservation was achieved by single dose of cardioplegic solution， and this method could be used in different kinds of heart surgery. 　　Key words：Cardiopulmonary bypass；Cardioplegia perfusion；Cardioprotection 　　心肌保护是心肺转流(Cardiopulmonary by-pass, CPB)心内直视手术成功的重要因素之一,心脏停搏液灌注的方法历来是备受关注的热点，本文对手术中主动脉阻断时间超过60 min的病例采用单次灌注停搏液的方法,以探讨单次灌注停搏液对心肌的影响及保护的效果。 　　1 资料与方法