经冠状静脉窦逆行灌注心脏跳动中主动脉瓣置换术（附5例报告）

摘要

Continuous retrograde coronary sinus perfusion（CRCSP） withbeating heart was performed in three patients of aortic stenosis and insufficiency undergoing aortic valve replacement and two patients of aortic stenosis and insufficiency concurrent mitral stenosis and insufficiency undergoing aortic valve combined with mitral valve replacement.During operation the heart was perfused with oxygened blood.To determine the content of creatine phosphokinse（CPK）and lactic dehydrogonase（LDH）before and after operation.After operation，all patients had a good recovery and did not develope any serious arrhythmia or low-output syndrome or embolism of gas embolus.Dopamine was used postoperatively 0～5μg／（kg.min）.The difference content of CPK and the difference content of LDH have no significance bofore and after operation.CRCSP with beating heart under extracorporeal circulation with low dose temperature is a simpl，safe and physiological myocardial protection method.%对3例主动脉瓣狭窄并关闭不全、2例主动脉瓣狭窄关闭不全并二尖瓣狭窄关闭不全患者，经冠状静脉窦逆行灌注，在心脏有节律的空跳中施行主动脉瓣置换或主动脉瓣二尖瓣双瓣置换手术。在整个手术过程中，心脏持续得到氧合血的供应，并测定术中及术后血清肌酸激酶（CPK）及乳酸脱氢酶（LDH）含量。结果术后患者恢复顺利，多巴胺用量少，未出现低心排出量综合征、严重心律失常及气体栓塞等严重并发症，术中及术后CPK及LDH含量无显著性差异。认为浅低温体外循环经冠状静脉窦逆行灌注心脏不停跳技术是一种简单、安全、接近生理状态的心肌保护措施。