逆行灌注在DeBakeyI型夹层动脉瘤术中的心肌保护作用

Investigation of myocardial protection of retrograde coronary sinus cardioplegia in Debakey type I aortic dissection operation under cardiopulmnory bypass

关键词:  DeBakeyI型夹层动脉瘤  经冠状窦逆行灌注  体外循环

Key words:  DeBakey type I aortic dissection  retrograde coronary sinus cardioplegia  cardiopulmnory bypass

摘要:

［目的］探讨经冠状窦逆行灌注方法在DeBakeyI型夹层动脉瘤手术中的心肌保护效果。［方法］ 2003年3月～2005年8月对33例DeBakeyI型夹层动脉瘤患者在体外循环下施行了外科手术治疗。术中14例采用经冠状动脉开口直接灌注（简称直灌）、19例采用经冠状窦逆行灌注（简称逆灌）方法进行心肌保护。本组手术全部采用远端开放 吻合。体外循环采用深低温停循环、选择性脑灌注。［结果］逆灌组升主动脉阻断时间短于直灌组（P<0.05）。逆灌组自动复跳率(73.7%)高于直灌组(57.1%)，术后第1天血清CK-MB、cTnI均低于直灌组（P均<0.05），且直灌组发生1例冠状动脉开口损伤。［结论］逆灌比直灌心肌保护方式在DeBakeyI型夹层动脉瘤手术中有明显优势。

Abstract:

［Objective］ To study the myocardial protective effect of retrograde coronary sinus cardioplegia. ［Methods］ From March 2003 to August 2005, 33 patients with DeBakey type I aortic dissection underwent surgical treatment under cardiopulmonary bypass. 14 patients received antegrade cardioplegia and 19 patients received retrograde cardioplegia. Hypothermic circulatory arrest andselective cerebral perfusion was used in all patients. ［Results］ The time of cross-clamping used by retrograde cardioplegia group were shorter than antegradecardioplegia group. The rate of heart automatically recovering of retrograde cardioplegia group was higher and the CK-MB level in the first day after operation of retrograde cardioplegia group was lower than antegrade cardioplegia group. In addtion, one case of iatrogenic trauma of the coronary artery ostium occurred, but none occurred in retrograde cardioplegia group. ［Conclution］ Retrograde cardioplegia was superior to antegrade cardioplegia in operation of Debakey type I aortic dissection.