【摘要】：背景當(dāng)今心臟外科技術(shù)發(fā)展迅速,尤以微創(chuàng)、低齡、復(fù)雜為特點(diǎn),而長(zhǎng)時(shí)間保持無(wú)血的直視術(shù)野下進(jìn)行手術(shù),不可避免的要求有良好的心肌保護(hù)技術(shù)。經(jīng)歷多年的研究,成人的心肌保護(hù)理論已經(jīng)確立,但在兒童特別是小嬰兒,由于發(fā)育的不成熟,心肌結(jié)構(gòu)和代謝都不一樣,而目前對(duì)未成熟心肌的研究尚少,臨床使用較多的心肌保護(hù)液(或稱心臟停跳液)為細(xì)胞外液型停跳液,但也有使用細(xì)胞內(nèi)液型停跳液。因此可以通過臨床對(duì)比的研究方式,比較以康斯特保護(hù)液(HTK液)為代表的細(xì)胞內(nèi)液型晶體停跳液與以改良ST.ThomasⅡ?yàn)榇淼募?xì)胞外液型晶體停跳液的心肌保護(hù)效果。目的比較不同晶體停搏液對(duì)未成熟心肌的保護(hù)效果。方法2013年1月至2013年10月期間在我院住院行體外循環(huán)(CPB)心外直視手術(shù)治療的患者中,手術(shù)時(shí)年齡在3個(gè)月以內(nèi)的共74例,術(shù)中應(yīng)用改良St.ThomasⅡ晶體停搏液(對(duì)照組)37例,應(yīng)用康斯特保護(hù)液(HTK液)(實(shí)驗(yàn)組)37例。病種有室間隔缺損、房間隔缺損、法洛氏四聯(lián)癥、右室雙出口、完全性房室隔缺損等。兩組麻醉方式相同,CPB采用中度低溫,肛溫30℃時(shí)阻斷升主動(dòng)脈,同時(shí)主動(dòng)脈根部順行灌注。對(duì)照組灌注改良St.ThomasⅡ晶體停搏液;B液組灌注HTK液。觀察指標(biāo):在麻醉后、術(shù)后24小時(shí)及72小時(shí)時(shí)外周血血清的肌鈣蛋白Ⅰ(cTnⅠ)和肌酸磷酸激酶同工酶B(CKMB)、乳酸脫氫酶(LDH)濃度,CPB后心臟自動(dòng)復(fù)跳率,術(shù)后應(yīng)用正性肌力藥物,術(shù)后監(jiān)護(hù)天數(shù),術(shù)后當(dāng)天左室射血分?jǐn)?shù)(EF),主動(dòng)脈阻斷前及停止CPB前的右心房心肌組織的電鏡下超微結(jié)構(gòu)。結(jié)果自發(fā)性復(fù)跳率無(wú)差別,實(shí)驗(yàn)組正性肌力藥物,術(shù)后監(jiān)護(hù)的天數(shù)與對(duì)照組差異明顯,實(shí)驗(yàn)組的術(shù)后當(dāng)天左室EF優(yōu)于對(duì)照組,且術(shù)后24小時(shí)血清c TnⅠ及CKMB、LDH濃度顯著低于對(duì)照組,但術(shù)后72小時(shí)濃度與對(duì)照組比較無(wú)統(tǒng)計(jì)學(xué)意義。主動(dòng)脈阻斷前心肌線粒體基本正常,偶見基質(zhì)顆粒丟失或線粒體腫脹。停止CPB前,線拉體存在不同程度的損傷樣改變,如基質(zhì)外漏、嵴斷裂或空泡樣改變。主動(dòng)脈開放后兩組患兒心肌線粒體Flameng評(píng)分顯著增高(P0.01),對(duì)照組評(píng)分比實(shí)驗(yàn)組明顯增高(P0.05)。結(jié)論HTK液對(duì)未成熟心肌的保護(hù)作用明顯優(yōu)于改良St.ThomasⅡ液。
[Abstract]:Background Cardiac surgery technology is developing rapidly nowadays, especially with the characteristics of minimally invasive, low age and complex, and it is inevitable to have good myocardial protection technique to operate under the open vision field of blood free for a long time. After years of research, adult myocardial protection theory has been established, but in children, especially in small infants, the structure and metabolism of myocardium are different due to immature development. More cardioprotective fluids (or cardioplegia) are used in clinic as extracellular cardioplegia, but there are also intracellular cardioplegia. Therefore, we can compare the myocardial protective effects of intracellular liquid crystal cardioplegia (ICL) represented by Conster's protective liquid (HTK) and modified ST.Thomas 鈪，

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