经冠状静脉窦逆行灌注在主动脉瓣置换手术中的应用.docVIP

2018-03-20 01:26:12中国现代医生2018年1期 黄伟聪陆地程德志孙成超 表1两组手术情况 组别 n 体外循环时 间(min) 主动脉阻断 时间 (min) 自动/ 除颤复 跳 实验组 32 96.32±1.80 67.10±2」0 28/4* 对照组 26 96.43±2.10 64.52±2.02 19/7 注:与对照组比较，:PvO.05 表2 两组心肌生化指标结果 指标 组别 n T1 CK-MB(U/L) 实验组 32 8.80±0.12 1( 对照组 26 9.72±0.10 1( cTnI( |JLg/L) 实验组 32 4.75±0.03 4 对照组 26 4.84±0.02 4 ［ ］目的探討经冠状静脉窦逆行灌注在主动脉瓣置换手术中心肌保护的有效性。方法 纳入 我院2016年1?12月行主动脉瓣置换手术患者58例，进行围术期心肌保护研究。根据术中心脏灌 注停跳方式随机将患者分为两组：顺行性灌注组(对照组，n=26),主动脉根部或径冠状动脉开口 顺行性灌注冷血心脏停搏液；顺+逆行灌注组(实验组，n=32),顺行灌注诱导心脏停搏，再经冠状 静脉窦逆行灌注。观察两组患者早期临床疗效，用术期指标的变化情况。结果两组58例患者均安 全度过围术期，未出现死亡及重要脏器损害等并发症。实验组手术效果更佳，术中心脏自动复跳率、 复跳后ST段改变指标显著优于对照组，差异有统计学意义(PvO.05)。两组体外循环时间、主动 脉阻断时间、术后血清肌钙蛋口 l(cTnl)、肌酸激酶同功酶(CK-MB)指标比较无显著性差异(P0.05)。 结论经冠状静脉窦逆行灌注在主动脉瓣辻换手术中能够安全的应用，该方法心肌保护确切，且可避 免损伤冠脉开口，避免因心肌肥厚或冠脉狭窄导致的术中灌注不足等严重并发症的产生。 ［关键词］心肺转流；心肌保护；心脏瓣膜置换；冠状静脉窦灌注 ［中图分类号］R654.2 ［文献标识码］B ［文章编1673-9701 (2018) 01-0049-03 Application of retrograde coronary sinus perfusion in aortic valve replacement surgery HUANG Weicong LU Di CHENG Dezhi SUN Chengchao Department of Cardiothoracic Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China ［Abstract］ Objective To investigate the effectiveness of retrograde coronary sinus perfusion in myocardial protect!on during aortic valve replacement. Methods 58 patients undergoing aortic valve replacement surgery in our hospital from January to December 2016 were selected? The study of perioperative myocardial protection was carried out. According to the way of intraoperative heart perfusion arrest, the patients were randomly divided into two groups： Anterograde infusion group (control group, n二26), aortic root or diameter coronary artery anterograde perfusion of cold blood cardioplegic solution； anterograde+retrograde perfusion group (experimental group, n=32), antegrade perfusion-induced cardiac arrest, followed by retrograde perfusion via coronary sinus. The early clinical efficacy and the changes of perioperative indices were observed in the two groups of patients. Results A