CAJ | 학술논문

　　目的评价自体冷血停搏液对心脏瓣膜置换术患者心肌损伤的影响。方法择期行心脏瓣膜置换术患者60例，年龄21~67岁，体质量指数18~25 kg/m2，ASA分级Ⅱ或Ⅲ级，采用随机数字表法，将患者分为2组（n=30）：对照组（应用St. Thomas晶体停搏液）和实验组（应用自体冷血停搏液）。实验组于阻断升主动脉即刻，经升主动脉根部灌注自体冷血停搏液20 mL/kg；对照组注射等容量的St. Thomas晶体停搏液。于主动脉阻断前5 min（T0，基础值）、主动脉开放后即刻（T1），术毕（T2），术后12 h（T3）和术后24 h（T4）时采集中心静脉血样，测定血浆磷酸肌酸激酶同工酶（CK-MB）活性和心肌肌钙蛋白Ⅰ（cTnⅠ）浓度。记录心脏停搏诱导时间、心脏自动复跳情况及体外循环后24 h多巴胺用量。结果与对照组比较，实验组T1~4时血浆CK-MB活性和cTnⅠ浓度均明显降低（P＜0.05），心脏停搏诱导时间明显缩短（P＜0.05），心脏自动复跳率明显升高（P＜0.05），体外循环后24 h多巴胺用量明显减少（P＜0.05）。结论自体冷血停搏液可在一定程度上减轻心脏瓣膜置换术患者心肌损伤。
　　목적평개자체랭혈정박액대심장판막치환술환자심기손상적영향。방법택기행심장판막치환술환자60례，년령21~67세，체질량지수18~25 kg/m2，ASA분급Ⅱ혹Ⅲ급，채용수궤수자표법，장환자분위2조（n=30）：대조조（응용St. Thomas정체정박액）화실험조（응용자체랭혈정박액）。실험조우조단승주동맥즉각，경승주동맥근부관주자체랭혈정박액20 mL/kg；대조조주사등용량적St. Thomas정체정박액。우주동맥조단전5 min（T0，기출치）、주동맥개방후즉각（T1），술필（T2），술후12 h（T3）화술후24 h（T4）시채집중심정맥혈양，측정혈장린산기산격매동공매（CK-MB）활성화심기기개단백Ⅰ（cTnⅠ）농도。기록심장정박유도시간、심장자동복도정황급체외순배후24 h다파알용량。결과여대조조비교，실험조T1~4시혈장CK-MB활성화cTnⅠ농도균명현강저（P＜0.05），심장정박유도시간명현축단（P＜0.05），심장자동복도솔명현승고（P＜0.05），체외순배후24 h다파알용량명현감소（P＜0.05）。결론자체랭혈정박액가재일정정도상감경심장판막치환술환자심기손상。
Objective To investigate the effects of cold autologous blood cardioplegic solution on myocardial injury in patients undergoing cardiac valve replacement. Methods Sixty ASAⅡ or Ⅲ patients aged 21~67 yr with BMI of 18~25 kg/m2 undergoing cardiac valve replacement were randomly divided into 2 groups (n=30):control group (St. Thomas cardioplegic solution) and experimental group (cold autologous blood cardioplegic solution). In experimental group, myocardial arrest was produced by infusing cold autologous blood cardioplegic solution 20 mL/kg through aortic root after aorta was cross-clamped;in control group, only given equal amount of St. Thomas cardioplegic solution. Blood samples were taken from central vein at 5 min before aortic cross-clamping (T0, baseline), immediately after aorta opening (T1), at the end of the surgery (T2), and 12 h(T3) and 24 h(T4) after surgery for determination of plasma creatine kinase-MB (CK-MB) activity and cardiac troponin Ⅰ (cTnⅠ) concentration. The cardiac arrest induction time (from infusion of cardioplegic solution to asystole shown by ECG), restoration of spontaneous heartbeat and the total amount of dopamine administered during the 24 h after cardiopulmonary bypass were recorded. Results Compared with control group, the plasma CK-MB activity and cTnⅠ concentration were significantly decreased at T1~4 (P<0.05), cardiac arrest induction time was shortened (P<0.05), the rate of spontaneous return of heartbeat was significantly increased (P<0.05), the total amount of dopamine administered during the 24 h after cardiopulmonary bypass was significantly decreased (P<0.05) in experimental group. Conclusion Cold autologous blood cardioplegic solution can attenuate myocardial injury in patients undergoing cardiac valve replacement.