CAJ | 학술논문

目的：观察在婴幼儿体外循环（ CPB）中采用自制微量晶体心肌保护灌注方法的临床效果。方法选择10 kg以下择期在CPB下行室间隔缺损修补术的患儿100例，随机分为试验组和对照组，每组各50例。心肌保护均采用顺行灌注高K＋含血停搏液，试验组采用微量晶体灌注方法，对照组采用传统储血罐灌注方法。分别于麻醉诱导后（ T1）、CPB 20 min（ T2）、主动脉开放后（ T3）、手术结束即刻（ T4）检测动脉血气的K＋离子浓度、红细胞比容（ Hct）、乳酸（ Lac）并进行比较，比较患儿术前和术后一般情况、左室射血分数（ EF）、CPB时间、主动脉阻断时间、心脏复苏、术中超滤量、CPB预充总量、围术期用血量，肌酸激酶（ CK）和肌酸激酶同工酶（ CKMB）等数据。结果①两组患儿术前一般情况、术前和术后EF值、CPB时间、阻断时间、心脏复苏率、术中超滤量无统计学差异（ P＞0．05）。②T1、T2、T3、T4的动脉血气K＋、Hct、Lac均无统计学差异（ P＞0．05）。③两组患儿CK、CKMB在术前、术后1天、术后3天各时间点组间比较均无统计学差异（ P＞0．05），但CK、CKMB在术后1天明显升高，与术前比较有显著差异（ P＜0．01），术后3天较术后1天明显下降（ P＜0．01），但仍高于术前水平（ P＜0．05）。④试验组较对照组CPB预充总量和围术期用血量均明显减少（ P＜0．05）。结论在婴幼儿CPB中的心肌保护使用微量晶体灌注方法能获得与储血罐灌注法相同的效果，但预充液总量和围术期用血量明显减少。
목적：관찰재영유인체외순배（ CPB）중채용자제미량정체심기보호관주방법적림상효과。방법선택10 kg이하택기재CPB하행실간격결손수보술적환인100례，수궤분위시험조화대조조，매조각50례。심기보호균채용순행관주고K＋함혈정박액，시험조채용미량정체관주방법，대조조채용전통저혈관관주방법。분별우마취유도후（ T1）、CPB 20 min（ T2）、주동맥개방후（ T3）、수술결속즉각（ T4）검측동맥혈기적K＋리자농도、홍세포비용（ Hct）、유산（ Lac）병진행비교，비교환인술전화술후일반정황、좌실사혈분수（ EF）、CPB시간、주동맥조단시간、심장복소、술중초려량、CPB예충총량、위술기용혈량，기산격매（ CK）화기산격매동공매（ CKMB）등수거。결과①량조환인술전일반정황、술전화술후EF치、CPB시간、조단시간、심장복소솔、술중초려량무통계학차이（ P＞0．05）。②T1、T2、T3、T4적동맥혈기K＋、Hct、Lac균무통계학차이（ P＞0．05）。③량조환인CK、CKMB재술전、술후1천、술후3천각시간점조간비교균무통계학차이（ P＞0．05），단CK、CKMB재술후1천명현승고，여술전비교유현저차이（ P＜0．01），술후3천교술후1천명현하강（ P＜0．01），단잉고우술전수평（ P＜0．05）。④시험조교대조조CPB예충총량화위술기용혈량균명현감소（ P＜0．05）。결론재영유인CPB중적심기보호사용미량정체관주방법능획득여저혈관관주법상동적효과，단예충액총량화위술기용혈량명현감소。
Objective To observe the clinical effect of myocardial protection using micro pump crystal solution perfusion de-vice in infants'congenital heart diseases with cardiopulmonary bypass ( CPB) . Methods Form Jun. 2010 to Oct. 2012, 100 infants ( body weight <10 kg) with ventricular septal defect ( VSD) scheduled for cardiac surgery with CPB were enrolled and randomized into experimental ( E) group and control ( C) group, 50 cases each. After aortic cross clamping, the way of antegrade cardioplegia perfusion with hyperpotassemia ( potassium 20 mmol/L) was chosen as myocardial protection method for all infants. Micro pump crystal solution perfusion device was used in E group and traditional blood reservoir perfusion device was used in C group. The concentrations of potas-sium, hematocrit ( Hct) , lactate ( Lac) from the arterial blood gas were compared between two groups at following time points:preop-eration (T1), 20 min after CPB (T2), aortic declamping (T3), leaving operating room (T4). The time of CPB and aortic cross clamping, cardiac resuscitation rate, filter fluid during CPB, total volume of CPB priming and banked red blood cell ( BRBC) transfu-sion perioperative, left ventricle ejection fraction (EF) and blood concentration of creatine kinase (CK), creatine kinase MB (CK-MB) before and after operation of two groups were collected. Results 1.There were no significant differences in preoperative and post-operative EF, time of CPB and aortic cross clamping, cardiac resuscitation rate between two groups ( P>0.05) . 2. There were no sig-nificant differences in the concentrations of potassium, hematocrit ( Hct) , lactate ( Lac) from the arterial blood gas between two groups in T1, T2, T3, T4 ( P>0.05) . 3. The concentration of CK and CKMB on the preoperative day, 1 day and 3 day postoperatively be-tween two groups had no significant differences ( P>0.05) , which was increased significantly on the 1 day postoperatively ( P<0.01) and recovered on 3 day postoperatively. 4. There were significant differences in the total volume of CPB priming and perioperative BRBC transfusion between two groups ( P<0.05). Conclusion The micro pump crystal solution perfusion device can provide comparative myocardial protective effect as traditional blood reservoir perfusion device, but the former can reduce the volume of CPB priming and perioperative BRBC transfusion in infants'congenital heart diseases with CPB.