CAJ | 학술논문

目的探讨婴幼儿法洛四联症根治术中行心肌缺血后处理的心肌保护作用,以改善患者的近期预后.方法 64例婴幼儿法洛四联症患者随机分成两组,每组32例,对照组行常规手术,观察组给予3个周期的缺血后处理.观察手术临床指标:体外循环时间、主动脉阻断时间、自动复跳率、后并行至脱机时间、脱机后血压、脱机后多巴胺使用量、拔管时间、ICU滞留时间、术后并发症;并检测实验室指标:麻醉诱导后和主动脉阻断后10 min、主动脉开放后10 min、ICU 1 h、术后1 d、术后2 d血浆中肌钙蛋白Ⅰ和肌酸磷酸激酶同工酶的水平.结果全组死亡2例(3.1%).其余患儿均治愈出院.两组术中术后实验室指标差异均有统计学意义(均P＜0.05),临床指标差异均无统计学意义(均P＞0.05).但对于主动脉阻断时间大于60 min的亚组,临床指标差异均有统计学意义(均P＜0.05).结论缺血后处理在婴幼儿法洛四联症根治术中能增强心肌保护作用,对于主动脉阻断时间大于60 min的病例,其临床意义尤为明显.
목적 탐토영유인법락사련증근치술중행심기결혈후처리적심기보호작용,이개선환자적근기예후.방법 64례영유인법락사련증환자수궤분성량조,매조32례,대조조행상규수술,관찰조급여3개주기적결혈후처리.관찰수술림상지표:체외순배시간、주동맥조단시간、자동복도솔、후병행지탈궤시간、탈궤후혈압、탈궤후다파알사용량、발관시간、ICU체류시간、술후병발증;병검측실험실지표:마취유도후화주동맥조단후10 min、주동맥개방후10 min、ICU 1 h、술후1 d、술후2 d혈장중기개단백Ⅰ화기산린산격매동공매적수평.결과 전조사망2례(3.1%).기여환인균치유출원.량조술중술후실험실지표차이균유통계학의의(균P＜0.05),림상지표차이균무통계학의의(균P＞0.05).단대우주동맥조단시간대우60 min적아조,림상지표차이균유통계학의의(균P＜0.05).결론 결혈후처리재영유인법락사련증근치술중능증강심기보호작용,대우주동맥조단시간대우60 min적병례,기림상의의우위명현.
Objective To investigate the myocardial protective effect of isehemic post-conditioning in total repair for tetralogy of fallot,in order to improve short-term prognosis of infant patients.Methods 64 cases of TOF infant patients were randomly divided into two groups,32 cases in the control group:conventional surgery without ischemic post-conditioning,and other 32 cases in the experimental group:given three cycles of ischemic post-conditioning.Then the clinical indieators:cardiopulmonary bypass time,aortic cross-clamping time,automatic re-jump rate,the latter parallel to the off-line time,the off-line blood pressure,the offline dopamine usage,extubation time,ICU stay time,postoperative complications,and the testing laboratory indicators:the cTnI and CK-MB levels in plasma after anesthesia induction,10min after aortic cross-clamping,10min after aortic opening,ICU1h,1d after surgery,and 2d after surgery were observed.Results Two patients were died and,mortality rate was 3.1%.The remaining patients were discharged from hospital.Laboratory indicators of the control group and the experimental group had significant differences (all P＜0.05),while the clinical indicators of the two groups had no significant differences(all P＞0.05).But for the sub-group which the aortic cross-clamping time were more than 60min,the clinical indicators were significantly different(all P＜0.05).Conclusion Ischemic post-conditioning could enhance myocardial protection in total repair for tetralogy,of fallot.for the cases aortic cross-clamping time was more than 60min,their clinical meanings were more obvious.