CAJ | 학술논문

目的：探讨在冠状动脉旁路移植术（ CABG）体外循环（ CPB）中采用自行设计的微量晶体心肌灌注法与不停跳法心肌保护的临床效果。方法选择择期在CPB下行单纯CABG患者40例，根据心肌保护方式不同随机分为微量晶体灌注组（ E组）和常规CPB不停跳组（ C组），每组各20例。于麻醉诱导后（ T0）、CPB 30 min（ T1）、CPB停机（ T2）、术后6 h（ T3）、术后12 h（ T4）、术后24 h（ T5）、术后48 h（ T6）分别比较两组患者动脉血气K＋、红细胞比容（ Hct）、乳酸（ Lac）及磷酸肌酸激酶同工酶（ CKMB）、心肌肌钙蛋白I（ cTnI）浓度，记录术前一般情况、搭桥支数、CPB时间、手术时间、呼吸机使用时间、ICU停留时间。结果两组患者均顺利出院，无死亡病例。 E组CPB时间及手术时间明显长于C组（ P＜0．05），T1～T2 E组K＋浓度显著高于C组（ P＜0．01）；T1～T6各时间点两组患者CKMB、cTnI浓度均明显高于术前水平（ P＜0．01或P＜0．05），E组CKMB、cTnI浓度均比C组高，但组间比较没有统计学差异（ P＞0．05）；各时间点两组间Hct、Lac浓度及术前一般情况、搭桥支数、呼吸机使用时间、ICU停留时间比较均无统计学意义（ P＞0．05）。结论在冠心病CPB中采用微量晶体灌注法能获得与常规CPB不停跳相似的心肌保护效果，在临床中可以安全使用。
목적：탐토재관상동맥방로이식술（ CABG）체외순배（ CPB）중채용자행설계적미량정체심기관주법여불정도법심기보호적림상효과。방법선택택기재CPB하행단순CABG환자40례，근거심기보호방식불동수궤분위미량정체관주조（ E조）화상규CPB불정도조（ C조），매조각20례。우마취유도후（ T0）、CPB 30 min（ T1）、CPB정궤（ T2）、술후6 h（ T3）、술후12 h（ T4）、술후24 h（ T5）、술후48 h（ T6）분별비교량조환자동맥혈기K＋、홍세포비용（ Hct）、유산（ Lac）급린산기산격매동공매（ CKMB）、심기기개단백I（ cTnI）농도，기록술전일반정황、탑교지수、CPB시간、수술시간、호흡궤사용시간、ICU정류시간。결과량조환자균순리출원，무사망병례。 E조CPB시간급수술시간명현장우C조（ P＜0．05），T1～T2 E조K＋농도현저고우C조（ P＜0．01）；T1～T6각시간점량조환자CKMB、cTnI농도균명현고우술전수평（ P＜0．01혹P＜0．05），E조CKMB、cTnI농도균비C조고，단조간비교몰유통계학차이（ P＞0．05）；각시간점량조간Hct、Lac농도급술전일반정황、탑교지수、호흡궤사용시간、ICU정류시간비교균무통계학의의（ P＞0．05）。결론재관심병CPB중채용미량정체관주법능획득여상규CPB불정도상사적심기보호효과，재림상중가이안전사용。
[ Abstract]:Objective To investigate the difference in the myocardial protective effect between the minimal cardioplegia and heart-beating in patients undergoing coronary artery bypass graft ( CABG) with cardiopulmonary bypass ( CPB) . Methods According to the different ways of myocardial protection, 40 patients in coronary artery disease undergoing CABG with CPB were included and ran?domized equally into two groups:experiment ( E) group and control ( C) group. E group we chose minimal cardioplegia with hyperpo?tassemia ( potassium 20 mmol/L) as the antegrade cardioplegia after aortic cross clamping, C group we chose conventional CPB with beating heart. The concentrations of potassium, hematocrit ( Hct) , lactate ( Lac) from the arterial blood gas and plasma levels of cardi?ac Troponin I ( cTnI) , creatine kinase MB ( CKMB) were compared among two groups at following time point:preoperation( T0) , 30 min after CPB ( T1) , end of CPB ( T2) , 6 h ( T3) ,12 h ( T4) ,24 h ( T5) and 48 h ( T6) after surgery. Preoperative general situation and counts of graft, time of CPB, operation, mechanical ventilation and ICU stay were also collected. Results There was no hospital death in either group. The time of CPB and operation in E group were obviously longer than C group ( P<0.05);the concentrations of potassium in E group were significant higher than C group in T1 and T2( P<0.01);plasma levels of CKMB and cTnI were significant higher than preoperation form T1 to T6 in two groups( P<0.01or P<0.05);plasma levels of CKMB and cTnI in E group were higher than C group, but there were not statistical difference between two groups form T1 to T6 ( P>0.05);there was no significant difference in the concentration of Hct, Lac and preoperative general situation and counts of graft, time of mechanical ventilation and ICU staybetween two groups ( P>0.05). Conclusion The minicardioplegia can provide comparative myocardial protective effect as conven?tional CPB with beating heart, and minicardioplegia can be used in patients undergoing CABG with CPB safely.