Olivier Baron, Jean-Christian Roussel, Odile Delaroche, Stéphanie Péron, Daniel Duveau
{"title":"三种血液停搏技术在低危CABG患者中的前瞻性临床和生物学比较:好不如好","authors":"Olivier Baron, Jean-Christian Roussel, Odile Delaroche, Stéphanie Péron, Daniel Duveau","doi":"10.1016/S0967-2109(03)00113-3","DOIUrl":null,"url":null,"abstract":"<div><p><em>Objective</em><span><span>: Three myocardial protection techniques were evaluated in a prospective, randomised trial during </span>coronary artery bypass grafts in 69 patients.</span></p><p><em>Material and method</em><span>: Twenty seven patients received intermittent hyperkalaemic undiluted warm blood anterograde cardioplegia (AC), 21 received continuous hyperkalaemic undiluted warm blood retrograde cardioplegia (RC) and 21 received intermittent, hyperkalaemic, diluted cold blood (15 °C), anterograde cardioplegia (CC). Assessment criteria were clinical, laboratory and haemodynamic.</span></p><p><em>Results</em><span><span><span>: Groups were homogeneous in terms of age, sex, cardiovascular risk factors, severity of coronary disease, preoperative </span>ejection fraction<span>, and number of bypass grafts performed. The oxygen extraction coefficient, and lactate and troponin production in the </span></span>coronary sinus on aortic unclamping was not significantly different between the three groups. The base excess was −0.19±0.13 in the RC group, −0.18±0.52 in the AC group and −2.67±0.59 in the CC group (</span><em>P</em><0.01 CC vs. AC and CC vs. RC). The priming volume was 1485±64 ml (CC), 1317±44 ml (RC) and 1318±30 ml (AC) (<em>P</em><0.05 CC vs. AC and CC vs. RC). The haematocrit during CPB was 28.9±0.9 (CC), 32.5±0.8 (RC) and 32±0.7 (AC) (<em>P</em><0.05 CC vs. AC and CC vs. RC). The volume of crystalloid delivered was 735±85 ml (CC), 362±67 ml (RC) and 357±105 ml (AC) (<em>P</em><span><0.05 CC vs. AC and CC vs. RC). The incidence of ventricular fibrillation on aortic unclamping was 61.9% (CC), 9.5% (RC) and 0% (AC) (</span><em>P</em><span><0.01 CC vs. AC and CC vs. RC). The transfusion rate, duration of intubation, postoperative troponin level, complication rate and mortality were not significantly different between the three groups. Haemodynamic parameters at H2, H4, H8 did not vary significantly between the three groups.</span></p><p><em>Conclusion</em><span>: These three techniques appear to be comparable in terms of myocardial protection. Anterograde cardioplegia ensures an identical degree of security to retrograde cardioplegia regardless of the coronary lesions, apart from redo lesions. CC requires greater haemodilution of the patients during CPB.</span></p></div>","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"11 6","pages":"Pages 489-495"},"PeriodicalIF":0.0000,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0967-2109(03)00113-3","citationCount":"0","resultStr":"{\"title\":\"Prospective clinical and biological comparison of three blood cardioplegia techniques in low-risk CABG patients: better is worse than good enough\",\"authors\":\"Olivier Baron, Jean-Christian Roussel, Odile Delaroche, Stéphanie Péron, Daniel Duveau\",\"doi\":\"10.1016/S0967-2109(03)00113-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p><em>Objective</em><span><span>: Three myocardial protection techniques were evaluated in a prospective, randomised trial during </span>coronary artery bypass grafts in 69 patients.</span></p><p><em>Material and method</em><span>: Twenty seven patients received intermittent hyperkalaemic undiluted warm blood anterograde cardioplegia (AC), 21 received continuous hyperkalaemic undiluted warm blood retrograde cardioplegia (RC) and 21 received intermittent, hyperkalaemic, diluted cold blood (15 °C), anterograde cardioplegia (CC). Assessment criteria were clinical, laboratory and haemodynamic.</span></p><p><em>Results</em><span><span><span>: Groups were homogeneous in terms of age, sex, cardiovascular risk factors, severity of coronary disease, preoperative </span>ejection fraction<span>, and number of bypass grafts performed. The oxygen extraction coefficient, and lactate and troponin production in the </span></span>coronary sinus on aortic unclamping was not significantly different between the three groups. The base excess was −0.19±0.13 in the RC group, −0.18±0.52 in the AC group and −2.67±0.59 in the CC group (</span><em>P</em><0.01 CC vs. AC and CC vs. RC). The priming volume was 1485±64 ml (CC), 1317±44 ml (RC) and 1318±30 ml (AC) (<em>P</em><0.05 CC vs. AC and CC vs. RC). The haematocrit during CPB was 28.9±0.9 (CC), 32.5±0.8 (RC) and 32±0.7 (AC) (<em>P</em><0.05 CC vs. AC and CC vs. RC). The volume of crystalloid delivered was 735±85 ml (CC), 362±67 ml (RC) and 357±105 ml (AC) (<em>P</em><span><0.05 CC vs. AC and CC vs. RC). The incidence of ventricular fibrillation on aortic unclamping was 61.9% (CC), 9.5% (RC) and 0% (AC) (</span><em>P</em><span><0.01 CC vs. AC and CC vs. RC). The transfusion rate, duration of intubation, postoperative troponin level, complication rate and mortality were not significantly different between the three groups. Haemodynamic parameters at H2, H4, H8 did not vary significantly between the three groups.</span></p><p><em>Conclusion</em><span>: These three techniques appear to be comparable in terms of myocardial protection. Anterograde cardioplegia ensures an identical degree of security to retrograde cardioplegia regardless of the coronary lesions, apart from redo lesions. CC requires greater haemodilution of the patients during CPB.</span></p></div>\",\"PeriodicalId\":79324,\"journal\":{\"name\":\"Cardiovascular surgery (London, England)\",\"volume\":\"11 6\",\"pages\":\"Pages 489-495\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2003-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/S0967-2109(03)00113-3\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular surgery (London, England)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0967210903001133\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular surgery (London, England)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0967210903001133","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的:在一项前瞻性随机试验中，对69例冠状动脉搭桥术患者的三种心肌保护技术进行评估。材料与方法:27例患者接受间歇性高钾血症非稀释温血顺行性心脏骤停(AC)， 21例患者接受持续高钾血症非稀释温血逆行性心脏骤停(RC)， 21例患者接受间歇性高钾血症稀释冷血(15℃)顺行性心脏骤停(CC)。评估标准为临床、实验室和血流动力学。结果:各组在年龄、性别、心血管危险因素、冠状动脉疾病严重程度、术前射血分数和行搭桥手术次数方面均相同。主动脉解夹时冠状动脉窦内的吸氧系数、乳酸和肌钙蛋白的生成在三组间无显著差异。RC组的基底过量为- 0.19±0.13,AC组为- 0.18±0.52,CC组为- 2.67±0.59 (P<0.01 CC vs. AC, CC vs. RC)。启动体积分别为1485±64 ml (CC)、1317±44 ml (RC)和1318±30 ml (AC) (P<0.05 CC vs. AC, CC vs. RC)。CPB期间红细胞压积分别为28.9±0.9 (CC)、32.5±0.8 (RC)和32±0.7 (AC) (P<0.05 CC vs. AC, CC vs. RC)。晶体递送体积分别为735±85 ml (CC)、362±67 ml (RC)和357±105 ml (AC) (P<0.05 CC vs. AC, CC vs. RC)。主动脉打开时心室颤动的发生率分别为61.9% (CC)、9.5% (RC)和0% (AC) (P<0.01 CC vs. AC和CC vs. RC)。三组患者输血率、插管时间、术后肌钙蛋白水平、并发症发生率及死亡率差异无统计学意义。三组间H2、H4、H8血流动力学参数差异无统计学意义。结论:三种方法在心肌保护方面具有可比性。除了重做病变外，无论冠状动脉病变如何，顺行心脏停搏术确保了与逆行心脏停搏术相同程度的安全性。CC需要在CPB期间对患者进行更大的血液稀释。
Prospective clinical and biological comparison of three blood cardioplegia techniques in low-risk CABG patients: better is worse than good enough
Objective: Three myocardial protection techniques were evaluated in a prospective, randomised trial during coronary artery bypass grafts in 69 patients.
Material and method: Twenty seven patients received intermittent hyperkalaemic undiluted warm blood anterograde cardioplegia (AC), 21 received continuous hyperkalaemic undiluted warm blood retrograde cardioplegia (RC) and 21 received intermittent, hyperkalaemic, diluted cold blood (15 °C), anterograde cardioplegia (CC). Assessment criteria were clinical, laboratory and haemodynamic.
Results: Groups were homogeneous in terms of age, sex, cardiovascular risk factors, severity of coronary disease, preoperative ejection fraction, and number of bypass grafts performed. The oxygen extraction coefficient, and lactate and troponin production in the coronary sinus on aortic unclamping was not significantly different between the three groups. The base excess was −0.19±0.13 in the RC group, −0.18±0.52 in the AC group and −2.67±0.59 in the CC group (P<0.01 CC vs. AC and CC vs. RC). The priming volume was 1485±64 ml (CC), 1317±44 ml (RC) and 1318±30 ml (AC) (P<0.05 CC vs. AC and CC vs. RC). The haematocrit during CPB was 28.9±0.9 (CC), 32.5±0.8 (RC) and 32±0.7 (AC) (P<0.05 CC vs. AC and CC vs. RC). The volume of crystalloid delivered was 735±85 ml (CC), 362±67 ml (RC) and 357±105 ml (AC) (P<0.05 CC vs. AC and CC vs. RC). The incidence of ventricular fibrillation on aortic unclamping was 61.9% (CC), 9.5% (RC) and 0% (AC) (P<0.01 CC vs. AC and CC vs. RC). The transfusion rate, duration of intubation, postoperative troponin level, complication rate and mortality were not significantly different between the three groups. Haemodynamic parameters at H2, H4, H8 did not vary significantly between the three groups.
Conclusion: These three techniques appear to be comparable in terms of myocardial protection. Anterograde cardioplegia ensures an identical degree of security to retrograde cardioplegia regardless of the coronary lesions, apart from redo lesions. CC requires greater haemodilution of the patients during CPB.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
