CAJ | 학술논문

目的：探讨体外循环心直视下心脏瓣膜置换术中心脏局部低温的心肌保护作用。方法80例瓣膜置换的患者按手术类型分层，按随机数字表法分为对照组和试验组。对照组在体外循环心内直视瓣膜手术中心表面放置冰泥予局部降温，试验组则心表面不放置冰泥。用自动生化分析仪分别测定两组患者术前5 min（ T0），主动脉钳开放后5 min（ T1）、6 h（ T2）、24 h（ T3）时点血液肌酸激酶同工酶（ CK-MB）值，观察两组患者在心脏自动复跳率、血管活性药物用量、左侧胸腔渗液、肺不张、膈肌抬升数等方面的差异。结果两组各时点CK-MB差异有统计学意义，双瓣手术后CK-MB变化幅度大于单瓣手术（ P＜0.05）。两组间CK-MB变化差异无统计学意义（ P＞0.05）。两组术后均未见明显心功能不全，无死亡病例。与对照组比较，试验组术后心脏自动复跳率更高，而胸腔积液、肺不张等肺部并发症以及膈肌抬高发生率更低（ P＜0.05）。结论在体外循环心脏停跳心脏瓣膜置换手术中，心表面置冰并不能提供额外心肌保护，反而显著提高了肺部并发症率。
목적：탐토체외순배심직시하심장판막치환술중심장국부저온적심기보호작용。방법80례판막치환적환자안수술류형분층，안수궤수자표법분위대조조화시험조。대조조재체외순배심내직시판막수술중심표면방치빙니여국부강온，시험조칙심표면불방치빙니。용자동생화분석의분별측정량조환자술전5 min（ T0），주동맥겸개방후5 min（ T1）、6 h（ T2）、24 h（ T3）시점혈액기산격매동공매（ CK-MB）치，관찰량조환자재심장자동복도솔、혈관활성약물용량、좌측흉강삼액、폐불장、격기태승수등방면적차이。결과량조각시점CK-MB차이유통계학의의，쌍판수술후CK-MB변화폭도대우단판수술（ P＜0.05）。량조간CK-MB변화차이무통계학의의（ P＞0.05）。량조술후균미견명현심공능불전，무사망병례。여대조조비교，시험조술후심장자동복도솔경고，이흉강적액、폐불장등폐부병발증이급격기태고발생솔경저（ P＜0.05）。결론재체외순배심장정도심장판막치환수술중，심표면치빙병불능제공액외심기보호，반이현저제고료폐부병발증솔。
Objective To investigate the myocardial protection effect of topical ice slush in heart valve replacement during ex -tracorporeal circulation .Methods Eighty patients undergoing heart valve replacement were enrolled in the study .They were randomly divided into experimental and the control group by using stratified random sampling method according to operation types .In the control group,the heart was embedded in topical cooling with ice slush during the surgery .In the experimental group ,topical hypothermia was not used.The CK-MB was measured 5 minute before releasing aortic cross-clamp (T0),and 5 minute (T1),6 hour (T2) and 24 hour (T3) after releasing aortic cross-clamp in the both groups.Meanwhile,the heart beat recovery,vascular active drug dosage,left pleural effusion,atelectasis and number of diaphragmatic paralysis were observed .Results The value of CK-MB was increased significantly af-ter operation in the two groups compared to T 0(P<0.05).The value of CK-MB was greater after double valve replacement when com-pared with single valve replacement ( P<0.05 ) .There was no significant difference in the increasing trend of CK-MB between the two groups .No significant cardiac dysfunctions and no deaths appeared in the two groups .Compared with the control group ,the experimental group had highly automatic cardiac rebeating rate and significantly decreased the incidence of pulmonary complications and diaphrag -matic elevation .Conclusion Topical ice slush did not offer any additional cardiac protective benefit in heart valve replacement during cardiac arrest but significantly increased the incidence of pulmonary complications .