CAJ | 학술논문

目的：探讨风湿性心脏病瓣膜置换术中不同心肌保护方法对血清缺血修饰白蛋白（ IMA）水平的影响。方法：将46例需行瓣膜置换手术的患者分为2组。 A组术中采用温血连续灌注，B组采用冷血间断灌注。于术前、术中主动脉阻断5、30 min，主动脉开放前，停机后及术后第1、3及5天取静脉血，测定心肌酶谱，通过IMA白蛋白钴结合试验（ ACB试验）测定IMA水平，术后监测相关临床指标，比较2种心肌保护方法的效果。结果：主动脉阻断30 min、开放主动脉前以及停机后A组IMA （ACB）值均高于B组（P＜0．05）；A组术后第1、3天心肌酶水平低于B组，第5天A组CK仍低于B组（P＜0．05）；A组自动复跳率较B组明显升高（χ2＝13．200，P＜0．001），辅助循环时间和气管带管时间也较B组明显缩短（t＝2．406，2．234，P＜0．05）。结论：温血持续灌注对心肌保护的效果优于冷血间断灌注组。
목적：탐토풍습성심장병판막치환술중불동심기보호방법대혈청결혈수식백단백（ IMA）수평적영향。방법：장46례수행판막치환수술적환자분위2조。 A조술중채용온혈련속관주，B조채용랭혈간단관주。우술전、술중주동맥조단5、30 min，주동맥개방전，정궤후급술후제1、3급5천취정맥혈，측정심기매보，통과IMA백단백고결합시험（ ACB시험）측정IMA수평，술후감측상관림상지표，비교2충심기보호방법적효과。결과：주동맥조단30 min、개방주동맥전이급정궤후A조IMA （ACB）치균고우B조（P＜0．05）；A조술후제1、3천심기매수평저우B조，제5천A조CK잉저우B조（P＜0．05）；A조자동복도솔교B조명현승고（χ2＝13．200，P＜0．001），보조순배시간화기관대관시간야교B조명현축단（t＝2．406，2．234，P＜0．05）。결론：온혈지속관주대심기보호적효과우우랭혈간단관주조。
Aim:To compare the efficacy of cold-blood intermittent and warm-blood continuous perfusion in valve re-placement for patients with rheumatic heart disease .Methods:A total of 46 patients undergoing cardiac valve replacement operation were randomly divided into Group A and Group B .The traditional cold-blooded intermittent perfusion was used in Group B, and Group A adopted warm-blood continuous perfusion .The levels of myocardial enzymes were detected , and the serum content of ischemia modified albumin ( IMA) was also be tested by albumin cobalt binding test before operation , at 5 min, 30 min after aorta blocking , at the moment before aortic cross-release and after stopping cardiopulmonary bypass , and at the 1st,3rd and 5th day after the operation.Results: IMA in Group A at 30 min after aorta block,the moment before aortic cross-release, and after stopping cardiopulmonary bypass were higher than those in Group B (P<0.05).The serum levels of myocardial enzymes in Group A were lower than those in Group B at the 1st and 3rd day after the operation, and at the 5th day only the level of CK was still lower than that in Group B (P<0.05).The patients in Group A had a higher rate of spontaneous return of heartbeat , shorter auxiliary cycle time and shorter intubation time than Group B (χ2 =13.200, t=2.406, 2.234,P<0.05).Conclusion:Warm-blood continuous perfusion has better myocardial protection than cold-blood intermittent perfusion .