中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2013年
23期
88-90
,共3页
王建堂%马增山%董铭峰%马胜军
王建堂%馬增山%董銘峰%馬勝軍
왕건당%마증산%동명봉%마성군
心脏不停跳%体外循环%心肌保护%先天性心脏病
心髒不停跳%體外循環%心肌保護%先天性心髒病
심장불정도%체외순배%심기보호%선천성심장병
Beating heart%Cardiopulmonary bypass%Myocardial protection%Congenital heart disease
目的 评价心脏停跳与不停跳手术对先天性心脏病患者的心肌保护效果.方法 房间隔缺损(ASD)、室间隔缺损(VSD)、肺动脉瓣狭窄(PS)患者共116例,随机分为实验组(不停跳组)和对照组(停跳组).实验组在体外循环(CPB)心脏跳动状态下手术,对照组在CPB心脏停跳下手术,分别于术前及术后2、6、24、48 h采集血标本,检测血清肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)含量;记录CPB时间、术后48 h心律失常发生率、残余分流发生率、呼吸机支持时间、ICU滞留时间、术后住院天数.结果 两组术后各时点血清CK-MB、cTnⅠ、AST、LDH含量均显著高于术前(P＜0.01),但两组间各时点比较差异无统计学意义(P＞0.05);实验组CPB时间较对照组短(P＜0.01),其他临床观察指标与对照组比较差异无统计学意义(P＞0.05).结论 体外循环心脏不停跳心内直视手术能缩短CPB时间,但手术效果与停跳手术比较差异无统计学意义.
目的 評價心髒停跳與不停跳手術對先天性心髒病患者的心肌保護效果.方法 房間隔缺損(ASD)、室間隔缺損(VSD)、肺動脈瓣狹窄(PS)患者共116例,隨機分為實驗組(不停跳組)和對照組(停跳組).實驗組在體外循環(CPB)心髒跳動狀態下手術,對照組在CPB心髒停跳下手術,分彆于術前及術後2、6、24、48 h採集血標本,檢測血清肌痠激酶同工酶(CK-MB)、肌鈣蛋白Ⅰ(cTnⅠ)、天鼕氨痠氨基轉移酶(AST)、乳痠脫氫酶(LDH)含量;記錄CPB時間、術後48 h心律失常髮生率、殘餘分流髮生率、呼吸機支持時間、ICU滯留時間、術後住院天數.結果 兩組術後各時點血清CK-MB、cTnⅠ、AST、LDH含量均顯著高于術前(P＜0.01),但兩組間各時點比較差異無統計學意義(P＞0.05);實驗組CPB時間較對照組短(P＜0.01),其他臨床觀察指標與對照組比較差異無統計學意義(P＞0.05).結論 體外循環心髒不停跳心內直視手術能縮短CPB時間,但手術效果與停跳手術比較差異無統計學意義.
목적 평개심장정도여불정도수술대선천성심장병환자적심기보호효과.방법 방간격결손(ASD)、실간격결손(VSD)、폐동맥판협착(PS)환자공116례,수궤분위실험조(불정도조)화대조조(정도조).실험조재체외순배(CPB)심장도동상태하수술,대조조재CPB심장정도하수술,분별우술전급술후2、6、24、48 h채집혈표본,검측혈청기산격매동공매(CK-MB)、기개단백Ⅰ(cTnⅠ)、천동안산안기전이매(AST)、유산탈경매(LDH)함량;기록CPB시간、술후48 h심률실상발생솔、잔여분류발생솔、호흡궤지지시간、ICU체류시간、술후주원천수.결과 량조술후각시점혈청CK-MB、cTnⅠ、AST、LDH함량균현저고우술전(P＜0.01),단량조간각시점비교차이무통계학의의(P＞0.05);실험조CPB시간교대조조단(P＜0.01),기타림상관찰지표여대조조비교차이무통계학의의(P＞0.05).결론 체외순배심장불정도심내직시수술능축단CPB시간,단수술효과여정도수술비교차이무통계학의의.
Objective To evaluate the protective effects of cardiac arrest and beating heart on patients with congenital heart disease (CHD).Methods One hundred and sixteen CHD patients were randomly divided into experimental group (beating heart group) and control group (cardioplegia group).The experimental group received surgery on beating heart with cardiopulmonary bypass (CPB),cardiac arrest operation under CPB in the control group,respectively.Blood samples were taken and the serum levels of creatine kinase MB (CK-MB),troponin Ⅰ(cTnⅠ),aspartate aminotransferase (AST),lactate dehydrogenase (LDH) were detected before operation and 2,6,24,48 hours after operation.The clinical parameters including CPB times,incidence of arrhythmia,residual shunt occurred rate,duration of mechanical ventilation,ICU stay time and postoperative hospital stay were detected respectively.Results Postoperatively,the CK-MB,cTnⅠ,AST,LDH levels were significantly higher than those before (P ＜ 0.01),but there were no significant differences between the two groups (P ＞ 0.05) ; The CPB time of experimental group were shorter than that of control group (P ＜ 0.01).Other clinical parameters between the two groups showed no significant difference (P ＞ 0.05).Conclusions The beating heart surgery can simply shorten the operating time,but the effect on myocardial protection has no difference as compared with that of cardiac arrest surgery.
