冠状动脉旁路移植术心肌保护灌注方式的研究

目的：对我院1997年4月至2000年12月间，182例单纯冠脉搭桥术的心肌保护灌注方式对体外循环和术后恢复的影响进行回顾性研究。方法：将患者按心肌保护灌注方式分为4组。组1（顺灌，n=57),组2（顺灌＋桥灌，n=4)，组3（顺灌＋逆灌，n=10),组4（顺灌＋逆灌＋桥灌，n=74).各组均使用Stock-Ⅲ型人工心肺机和进口膜肺，升主动脉插管（22－24F）和腔房二级插管（38－42F）。4：1含血冷停跳液（BCD，Sorin Inc.)间断或连续灌注。比较各组患者临床资料，术中搭桥支数，体外循环时间，阻断时间，转流温度，血液稀释度，呼吸机时间，ICU天数，术后心功能和射血分数，多巴胺支持率和IABP使用率方面的差异。结果：stata软件统计，各组患者临床资料（年龄、体重、病变支数、术前心功能、射血分数）均衡，有良好的可比性（P＞0．05）。术中搭桥支数，术后呼吸机使用时间、ICU天数、术后心功能和射血分数，多巴胺支持率和IABP使用率各组之间无统计学差异（P＞0．05），体外循环时间、阻断时间、最低鼻咽温及最低肛温组4明显长于和低于组1和组2（P＜0．01）。血液稀释度组4高于组1（P＜0．05）。自动复苏率组4最低（79．73％，P＜0．01）。体外循环时间，阻断时间与术后多巴胺支持率呈正相关（P＜0．01）。各组心功能术后均改善，但射血分数与术前相比除组3外均有统计学差异（P＜0．01），术后低于术前。结论：顺灌、逆灌和桥灌等灌注方法单独或相结合使用均可得到良好的心肌保护效果。为减少手术操作时间和转流时间，避免副损伤可采用有效、简便行的顺灌心肌保护方法。

Study of different delivered methods of cardioplegia in coronary artery bypass graft

Objective:To study the affection of perfusion of cardioplegic solution with blood on cardiopulmonary bypass (CPB) and postoperative recover Methods: 182 patients underwent simple coronary artery bypass graft (CABG) were divided into 4 groups according to the ways of cardioplegia delivery Group 1: antegrade perfusion ( n =57); Group 2: combined antegrade and graftgrade perfusion ( n =41); Group 3: combined both perfusion ( n =10); Group 4:combined antegrade and retrograde and graftgrade perfusion( n =74) Sorin BCD were used in all patients 4:1 cool cardioplegic solution with blood was delivered interruptedly or continuously To compare the 4 groups in clinical materials, the CPB and the aortic clamp time, the lowest temperature, heamodilusion degree, rate of dopamine requirements and IABP usage, duration of respirator ventilation after operation and days in ICU, postoperative heart function and ejection fraction(EF) Results: There were no significant difference( P >0 05)among 4 groups in age, weight, pre operative heart function and EF, quantity of vessel coronary artery disease, duration of respirator ventilation and ICU days, post operative heart function and EF, rate of dopamine requirements and IABP usage There were positive correlation between quantity of CABG, rate of dopamine support and CPB time, aortic clamp time ( P <0 01) In group 4: CPB time, aortic clamp time, the lowest nasopharynx and anal temperature were significantly longer and lower( P <0 01)than group 1 and 2; heamodilution was significantly higher( P <0 05)than the group 1; the rate of auto resuscitation was the lowest( P <0 05) The postoperative heart function increased in all groups( P <0 01) The postoperative EF decreased significantly compared with preoperative ( P <0 01) except group 3 Conclusion: All the four methods can get the good results of myocardium protection Our data show that the interrupted antegrade perfusion was the most safety and convenient technique in shortening the CPB and aortic clamp time and reducing the operative risk in patients of simple CABG