中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2013年
6期
1305-1307
,共3页
谢晓勇%冯振博%郑宝石%何巍%冯旭%雷宾峰
謝曉勇%馮振博%鄭寶石%何巍%馮旭%雷賓峰
사효용%풍진박%정보석%하외%풍욱%뢰빈봉
重度主动脉瓣狭窄%左心室心肌肥厚%逆行灌注心脏不停跳%假体植入
重度主動脈瓣狹窄%左心室心肌肥厚%逆行灌註心髒不停跳%假體植入
중도주동맥판협착%좌심실심기비후%역행관주심장불정도%가체식입
Severe aortic valve stenosis%Left ventricular hypertrophy%Beating-heart cardiopulmonary bypass under retroperfusion%Prosthesis Implantation
目的 探讨逆行灌注心脏不停跳治疗重度主动脉瓣狭窄(AS)并左室肥厚心肌保护及临床效果.方法 重度AS并左室肥厚46例,分别采用不停跳和停跳手术,主要检测肌钙蛋白Ⅰ(Tropnin Ⅰ)、肌酸激酶同工酶MB(CK-MB)、乳酸脱氢酶(LDH)浓度及心肌丙二醛(MDA)含量.结果 两组比较,Tropnin Ⅰ浓度(μg/L)在主动脉开放15 min后4个时点,0.56±0.12比0.98±0.25、0.71 ±0.19比1.23 ±0.42、0.85 ±0.21比1.58 ±0.45、0.65 ±0.15比1.15±0.41；CK-MB浓度(U/L)在主动脉开放15 min、术后2h及术后2d3个时点,12.8 ±7.5比21.5±9.8、13.9±8.1比23.1 ±10.2、12.5±8.3比25.7±12.1;LDH浓度(U/L)在主动脉开放15 min、术后2h2个时点,301.8±151.6比422.7±163.5、405.4±161.2比615.1 ±172.3;心肌MDA浓度(mmol/g)在缝闭右房时,2.35 ±1.12比3.41 ±2.01,不停跳组明显低于停跳组(P＜0.01,P＜0.05),不停跳组死亡率低于停跳组.结论 逆行灌注心脏不停跳治疗重度AS并左室肥厚,具有很好的心肌保护及临床效果.
目的 探討逆行灌註心髒不停跳治療重度主動脈瓣狹窄(AS)併左室肥厚心肌保護及臨床效果.方法 重度AS併左室肥厚46例,分彆採用不停跳和停跳手術,主要檢測肌鈣蛋白Ⅰ(Tropnin Ⅰ)、肌痠激酶同工酶MB(CK-MB)、乳痠脫氫酶(LDH)濃度及心肌丙二醛(MDA)含量.結果 兩組比較,Tropnin Ⅰ濃度(μg/L)在主動脈開放15 min後4箇時點,0.56±0.12比0.98±0.25、0.71 ±0.19比1.23 ±0.42、0.85 ±0.21比1.58 ±0.45、0.65 ±0.15比1.15±0.41；CK-MB濃度(U/L)在主動脈開放15 min、術後2h及術後2d3箇時點,12.8 ±7.5比21.5±9.8、13.9±8.1比23.1 ±10.2、12.5±8.3比25.7±12.1;LDH濃度(U/L)在主動脈開放15 min、術後2h2箇時點,301.8±151.6比422.7±163.5、405.4±161.2比615.1 ±172.3;心肌MDA濃度(mmol/g)在縫閉右房時,2.35 ±1.12比3.41 ±2.01,不停跳組明顯低于停跳組(P＜0.01,P＜0.05),不停跳組死亡率低于停跳組.結論 逆行灌註心髒不停跳治療重度AS併左室肥厚,具有很好的心肌保護及臨床效果.
목적 탐토역행관주심장불정도치료중도주동맥판협착(AS)병좌실비후심기보호급림상효과.방법 중도AS병좌실비후46례,분별채용불정도화정도수술,주요검측기개단백Ⅰ(Tropnin Ⅰ)、기산격매동공매MB(CK-MB)、유산탈경매(LDH)농도급심기병이철(MDA)함량.결과 량조비교,Tropnin Ⅰ농도(μg/L)재주동맥개방15 min후4개시점,0.56±0.12비0.98±0.25、0.71 ±0.19비1.23 ±0.42、0.85 ±0.21비1.58 ±0.45、0.65 ±0.15비1.15±0.41；CK-MB농도(U/L)재주동맥개방15 min、술후2h급술후2d3개시점,12.8 ±7.5비21.5±9.8、13.9±8.1비23.1 ±10.2、12.5±8.3비25.7±12.1;LDH농도(U/L)재주동맥개방15 min、술후2h2개시점,301.8±151.6비422.7±163.5、405.4±161.2비615.1 ±172.3;심기MDA농도(mmol/g)재봉폐우방시,2.35 ±1.12비3.41 ±2.01,불정도조명현저우정도조(P＜0.01,P＜0.05),불정도조사망솔저우정도조.결론 역행관주심장불정도치료중도AS병좌실비후,구유흔호적심기보호급림상효과.
Objective To approach myocardial preservation and clinic effect of aortic valve replacement (AVR) on severe aortic valve stenosis (AS) with left ventricular hypertrophy with beating-heart under retroperfusion.Methods Forty-six cases of severe AS with left ventricular hypertrophy were randomly divided into two groups.Twenty-nine patients were subjected to AVR with beating-heart cardiopulmonary bypass under retroperfusion,and rest 17 received operation on arrested heart cardiopulmonary bypass.Curative effectiveness and prognosis were statistically analyzed.Venous blood was drawn to detect serum levels of Tropnin Ⅰ and myocardium enzyme.Results At certain time points,serum levels of Tropnin Ⅰ,CK-MB and lactate dehydrogenase (LDH) in beating-heart group were lower than in arrested heart group.In beating-heart group and arrested heart group,serum levels of Tropnin Ⅰ (μg/L) were as follows:(0.56 ±0.12) vs.(0.98±0.25),(0.71 ±0.19) vs.(1.23 ±0.42),(0.85 ±0.21) vs.(1.58 ±0.45),(0.65±0.15) vs.(1.15±0.41); CK-MB (U/L):(12.8±7.5) vs.(21.5±9.8),(13.9±8.1)vs.(23.1±10.2),(12.5 ±8.3) vs.(25.7 ±12.1); LDH (U/L):(301.8±151.6) vs.(422.7±163.5),(405.4 ± 161.2) vs.(615.1 ± 172.3).Postoperative mortality in beating-heart group was lower than in arrested heart group.Conclusion Beating-heart under retroperfusion could provide good myocardial preservation on AS patients with left ventricular hypertrophy,and has better clinic effects.
