CAJ | 학술논문

目的观察心脏不停跳修补室缺后肌钙蛋白T(cTnT)分泌变化.方法共施行单纯室间隔缺损(VSD)合并轻、中度肺动脉高压患者202例.VSD(0.7 ±0.2)cm;膜部185例,干下型15例,肌部2例.心胸比例0.49 ±0.18.随机分为3组:A组(晶体组)86例;B组(血灌组)51例;C组(不停跳组)65例.术中切取右心耳行电镜观察.术后24 h和72 h抽血监测cTnT.结果无气栓、死亡、严重低心排、肾功能或呼吸功能衰竭等严重并发症发生.术后1～2 d轻度血红蛋白尿5例.术后1～3 d暂时性房室分离7例.直径＜2 mm残余漏2例.C组2例术中室颤.手术后24 h的cTnT:A组(0.75±0.25)μg/L与B组(0.69 ±0.20)μg/L,P＞0.05,C组(0.55 ±0.18)μg/L与A、B组差异有统计学意义(P＜0.01).术后72 h的cTnT:A组(0.53 ±0.19)μg/L与C组(0.55±0.13)μg/L,P＞0.05,A组与B组(0.43±0.13)μg/L,P＜0.01.电镜发现3组之间,以C组损害略轻,A组相对较重.结论心脏跳动下修补可明显减少手术时间,由此可以减少由手术对全身造成的创伤,并且方法安全、可行.心脏不停跳修补的cTnT分泌变化反映了心肌保护效果:并不优于血灌组,两者皆优于晶体停跳组.
목적 관찰심장불정도수보실결후기개단백T(cTnT)분비변화.방법 공시행단순실간격결손(VSD)합병경、중도폐동맥고압환자202례.VSD(0.7 ±0.2)cm;막부185례,간하형15례,기부2례.심흉비례0.49 ±0.18.수궤분위3조:A조(정체조)86례;B조(혈관조)51례;C조(불정도조)65례.술중절취우심이행전경관찰.술후24 h화72 h추혈감측cTnT.결과 무기전、사망、엄중저심배、신공능혹호흡공능쇠갈등엄중병발증발생.술후1～2 d경도혈홍단백뇨5례.술후1～3 d잠시성방실분리7례.직경＜2 mm잔여루2례.C조2례술중실전.수술후24 h적cTnT:A조(0.75±0.25)μg/L여B조(0.69 ±0.20)μg/L,P＞0.05,C조(0.55 ±0.18)μg/L여A、B조차이유통계학의의(P＜0.01).술후72 h적cTnT:A조(0.53 ±0.19)μg/L여C조(0.55±0.13)μg/L,P＞0.05,A조여B조(0.43±0.13)μg/L,P＜0.01.전경발현3조지간,이C조손해략경,A조상대교중.결론 심장도동하수보가명현감소수술시간,유차가이감소유수술대전신조성적창상,병차방법안전、가행.심장불정도수보적cTnT분비변화반영료심기보호효과:병불우우혈관조,량자개우우정체정도조.
Objective To estimate the myocardial protective effect of the operation.Methods From January 2004 to June 2009,we implemented ventricular septal defect (VSD) repairs in 202 patients with simple VSD and mild and moderate pulmonary hypertension,including 98 males and 104 females.Theaverage size of VSD was (0.7 ±0.2) cm.There were 185 patients with perimenbranous VSD,15 patients with lower trunk VSD,and 2 patients with muscular VSD.The average cardiothoracic ratio (CTR) was 0.49 ±0.18.202 patients were randomly divided into 3 groups:group A (crystalloid group) with 86 cases;group B (hemoperfusion group) with 51 cases;group C (beating heart group) with 65 cases.During the operation,right atrial appendage muscle was cut off and observed under the electron microscopy.The blood cardiac Troponin T (cTnT) was examined 24 and 72 h postoperation.Results There was no air embolism,death,severe low cardiac output,renal or respiratory failure or other serious complications.One to2 days after surgery,5 cases had mild hemoglobinuria.One-3 days after surgery,7 cases had a temporary atrioventricular separation.There were 2 cases of residual leakage with the diameters both below 2 mm.Two cases in group C suffered from ventricular fibrillation during operation.At 24th h after surgery,there was no significant difference in cTnT ( P ＞ 0.05 ) between group A (0.75 ± 0.25 ) μg/L and group B (0.69 ±0.20) μg/L,and there was statistically great significant difference between group C (0.55 ±0.18) μg/L and groups A or B (P＜0.01).At tge 72nd h after surgery,there was no significant difference in the cTnT level ( P ＞ 0.05 ) between group A (0.53 ± 0.19 ) μg/L and group C ( 0.55 ± 0.13 )μg/L,but there was statistically great significant difference between group A and group B (0.43 ±0.13)μg/L (P ＜0.01 ).The damage in group C was milder,and that in group A was severer.Conclusion Beating heart surgery can significantly reduce the operative duration of VSD repair,thereby it can limit the surgical trauma on the body.Moreover,the method is conservative and practical.In terms of changes of cTnT secretion or myocardial protective effect for repair of VSD,the beating heart surgery was not superior to the hemoperfusion group while both of the groups were superior to the crystalloid group.