寒冷性心脏损伤后的心脏代谢和表现
R D Weisel1, I H Lipton, R N Lyall
1Division of Cardiovascular Surgery, University of Toronto, Ontario, Canada.
Circulation
|September 1, 1978
概括
寒冷性心脏 (CPC) 有效地保持心脏功能. 多次CPC剂量与低温更好地保护心脏在绕道手术期间比单次剂量,减少心脏损伤.
科学领域:
- 心血管外科心血管外科
- 心脏的新陈代谢.
- 肌心脏的保护 肌心脏的保护
背景情况:
- 动脉冠状动脉绕道手术需要心脏骤停,需要心肌保护策略.
- 寒冷性心脏 (CPC) 是一种常见的诱导心脏骤停和保存心脏的方法.
- 优化CPC协议对于尽量减少手术期间心肌损伤至关重要.
研究的目的:
- 评估单剂量与多剂量CPC与低温在保持心脏新陈代谢和性能中的有效性.
- 评估心肌温度,无氧时间和心脏损伤标志物之间的相关性.
- 确定不同CPC策略对术后心脏功能的影响.
主要方法:
- 68名接受冠状动脉绕道术的患者被分为两组:单剂量CPC (n=45) 和多剂量CPC与全身低温 (n=23).
- 对心肌温度进行监测,目标心肌平均温度 (MMT) 在I组为32°C/分钟,在II组为22°C/分钟.
- 通过动脉和冠状动脉鼻抽样评估心脏代谢,测量氧气提取,乳酸生产和CPK/CPK-MB释放.
- 术后心脏表现通过热稀释心脏输出和左心房压测量来评估心肌功能表现曲线.
主要成果:
- 与多剂量组相比,接受单剂量CPC (I组) 的患者表现出减少的氧气提取,增加的乳酸生产和更高的CPK/CPK-MB释放.
- 心脏损伤标志物与超过30分钟的无氧时间相关,在I组中观察到较长的无氧持续时间的损伤更大.
- 第一组患者在术后表现出对体积负荷的反应减弱,较低的中风工作和心脏输出上坡,与无氧时间相反相关.
结论:
- 多剂量冷性心脏损伤与全身低温相结合,与单剂量相比,提供更好的心肌保护.
- 达到较低的心肌平均温度 (22°C) 显著减少心肌损伤,并改善术后的心脏性能.
- 冠状动脉鼻采样和体积加载期间的血液动力学监测提供了对心肌保护疗效的客观评估,突出了仅仅临床参数的局限性.
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