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作者在实验研究的基础上,选择了临床资料相近的心脏瓣膜病患者20例,根据术中使用心脏停搏液不同,随机分为2组:①冷氧合血间歇灌注组(n=10);②持续温血停搏液组(n=10).观察了心肌能量代谢变化及血浆磷酸肌酸激酶同工酶(CPK-MB)的改变;同时亦进行了临床资料观察.结果:①冷血组CPK-MB变化于手术结束后开始明显升高,术后18h达高峰。温血组术后各期酶学指标与冷血组相比均明显降低(P<0.01).②心肌能量代谢变化:冷血组缺血未ATP,总腺苷酸(AN)含量及ATP/ADP比值分别下降至停搏前的0.50±0.18;0.58±0.16和0.59±0.18,明显低于温血组的0.87±0.23;0.92±0.19和0.86±0.22.③临床资料观察:温血组的自动复跳率及术后血管活性药物使用率优于冷血组,结论:持续灌注温血停搏技术可以充分保证心肌在常温停跳时的氧供,保存和增加心肌能量的储备,避免了心肌缺血缺氧期,是一种理想的心肌保护法.
On the basis of experimental study, 20 patients with valvular heart disease with similar clinical data were selected and randomly divided into 2 groups according to the intraoperative cardioplegic solution: ① intermittent cold oxygenated blood perfusion group (n = 10) ; ② continuous warm blood cardioplegia group (n = 10). Changes in myocardial energy metabolism and changes in plasma creatine kinase (CPK-MB) were observed. Clinical data were also observed. Results: ①The changes of CPK-MB in cold-blooded group began to increase significantly after operation, reaching the peak at 18 hours after operation. Compared with the cold-blooded group, the enzymological indexes of warm-blooded group were significantly decreased (P <0.01). ② The changes of myocardial energy metabolism: The content of ATP, total adenosine acid (AN) and ATP / ADP in cold-blooded group decreased to 0.50 ± 0.18, 0.58 ± 0.16 and 0 .59 ± 0.18, which was significantly lower than that of the warm-blooded group (0.87 ± 0.23; 0.92 ± 0.19 and 0.86 ± 0.22). ③ Clinical data observation: The rate of spontaneous rebound in warm-blooded group and the rate of postoperative vasoactive drug use is superior to cold-blooded group. Conclusion: Continuous perfusion warm-blooded arrest technique can fully guarantee oxygen supply, preservation and Increase myocardial energy reserve, to avoid myocardial ischemia and hypoxia, is an ideal method of myocardial protection.