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目的 观察婴儿体外循环心脏手术中不同压力灌注停搏液心肌保护的临床效果。方法 选择在体外循环、心脏停搏下行心室间隔缺损修补的婴儿 45例 ,按心肌保护液灌注压力不同随机分三组 :1组 ,P =6 0mmHg ;2组 ,P =45mmHg ;3组 ,P =30mmHg。观察 :①实验室指标术前、主动脉开放 (CCR)后 30min、6h、2 4h心肌酶 (CK MB、LDH)、心肌肌钙蛋白 (cTnI)浓度 ;②临床指标 :灌注诱导停搏时间 ;主动脉开放后复跳时间、自动转窦率 ;术后正性药物使用情况 ;呼吸机辅助时间、ICU(加强护理病房 )停留时间、术后住院时间。结果 ①灌注压力与诱导停搏时间、复跳时间呈负相关 ,诱导停搏时间、复跳时间组 (118.7± 5 .5 )s、(2 5 .1± 16 .0 )s小于组 3(2 3.7± 5 .5 )s、(4 3.7± 2 2 .1)s,P<0 .0 5 ;②自动转窦率组 2 (93.3% )高于组 1(86 .7% )、组 3(86 .7% ) ;③ 3组在CCR后各时点CK MB、LDH、cTnI与基础值相比均有明显升高 ,P <0 .0 1;CK MB、cTnI以CCR后 30min最高 ,与其他时点相比P <0 .0 5 ;LDH以CCR后 6h最高 ,与其他时点比较P <0 .0 5。组 1CCR后 6hLDH(6 92 .2 4± 139.9)U/L明显高于组 3(5 6 9.0± 10 8.5 )U/L ,P <0 .0 5 ;④术后多巴胺、多巴酚丁胺的使用量组间各时点无统计学差异 ,停机时组 1虽高于组 3;组
Objective To observe the clinical effects of cardioplegia with different pressure perfusion cardioplegia during cardiopulmonary bypass in infants. Methods Forty-five infants with ventricular septal defect repaired under cardiopulmonary bypass and cardiac arrest were randomly divided into three groups according to the perfusion pressure of cardioplegic solution: group 1, P = 60mmHg; group 2, P = 45mmHg; group 3, P = 30mmHg. Observations: ① Laboratory indexes CKMB, LDH and cTnI at 30min, 6h, 24h after aorta opening (CCR); ② clinical indexes: perfusion-induced arrest time; Aortic open after the resuscitation time, automatic sinus rate; postoperative positive drug use; ventilator support time, ICU (intensive care unit) stay, postoperative hospital stay. Results ① The perfusion pressure was negatively correlated with the time of induction of cardioversion and the time of reincarnation. The time of induction of cardioplegia and the time of reincarnation were (118.7 ± 5.5) s and (25.1 ± 16.0) s, respectively, less than that of group 3 2 3.7 ± 5 .5) s, (4 3.7 ± 2 2 .1) s, P <0. 05; ②Automatic sinus ratio group 2 (93.3%) was higher than group 1 3 (86.7%); ③The CK MB, LDH and cTnI in CCK group at 3 time point after CCR were significantly higher than those at baseline (P <0.01); CK MB and cTnI were the highest at 30 min after CCR , P <0.05 compared with other time points; LDH was the highest at 6h after CCR, P <0.05 compared with other time points. The 6hLDH (6 92 .2 4 ± 139.9) U / L in group 1CCR was significantly higher than that in group 3 (56 9.0 ± 10 8.5) U / L, P <0.05. (4) Postoperative dopamine, dobutamine The use of the amount of time between groups no statistically significant difference, while the shutdown group 1 is higher than the group 3; group