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目的:探讨磷酸肌酸钠液冷晶体停跳液对体外循环下房室间隔缺损修补术患儿心肌能量代谢和心肺功能的影响。方法:采用前瞻性随机对照研究。选取在南方医科大学附属佛山医院接受体外循环下行手术治疗的房室间隔缺损患儿48例，采用随机数字表法分为试验组和对照组，每组24例。对照组患儿男14例、女10例，年龄（7.2±3.4）岁，体质量（20.2±5.8）kg；试验组患儿男16例、女8例，年龄（7.0±3.4）岁，体质量（20.4±9.5）kg。对照组采用常规高钾冷液晶心脏停搏液，试验组在常规的冷晶体停跳液中加入磷酸肌酸钠，浓度为10 mmol/L。两组患儿均在体外循环下行心内直视房室间隔缺损修补术。观察和记录两组患儿体外循环时间、主动脉阻断时间、体外循环辅助时间、心脏自动复跳情况，以及术后多巴胺和肾上腺素的使用情况和术后呼吸机支持时间。分别于体外循环前（T0）、主动脉开放5 min（T1）、主动脉开放30 min（T2）、停机后4 h（T3）、停机后24 h（T4）抽取动脉血，采用免疫荧光法测定血肌酸激酶同工酶（CK-MB）和心肌钙蛋白I（cTnI）水平。分别于术前和术后1 d采取静脉血，采用高效液相法测定三磷酸腺苷（ATP）、二磷酸腺苷（ADP）、单磷酸腺苷（AMP）、磷酸肌酸（CP）的含量。采用n t检验、卡方检验和方差分析行统计学处理。n 结果:试验组和对照组的体外循环时间［（63.4±13.4）h比（67.1±19.8）h］、主动脉阻断时间［（30.9±11.6）h比（32.1±14.5）h］、体外循环辅助时间［（18.3±10.1）h比（22.3±9.3）h］以及心脏自动复跳率［100.0%（24/24）比100.0%（24/24）］比较差异均无统计学意义（均n P>0.05）。术后呼吸辅助时间试验组短于对照组［（6.7±2.3）h比（7.9±1.4）h］，差异有统计学意义（n t=2.18，n P=0.03）。试验组的CK-MB在T1、T2、T3和T4时点均明显低于对照组［（22.4±5.3）U/L比（27.5±7.7）U/L、（68.5±11.9）U/L比（80.4±16.7）U/L、（81.4±21.2）U/L比（98.5±34.7）U/L、（55.9±14.7）U/L比（67.3±17.6）U/L］，差异均有统计学意义（n t=2.67、2.84、2.06、2.44，均n P<0.05）；试验组cTnI在T1、T2、T3和T4时点均明显低于对照组［（7.4±3.1）μg/L比（9.9±2.3）μg/L、（6.0±2.2）μg/L比（8.9±4.0）μg/L、（6.4±3.3）μg/L比（8.6±4.1）μg/L、（6.8±2.6）μg/L比（8.9±3.4）μg/L］，差异均有统计学意义（n t=3.17、3.11、2.05、2.40，均n P<0.05）；试验组术后T4时点的ATP、ADP、AMP、CP水平均明显高于对照组，差异均有统计学意义（均n P<0.05）。试验组术后T4时点的氧合指数高于对照组［（331.6±43.3）比（273.7±33.3）］，差异有统计学意义（n t=2.90，n P0.05]. The postoperative ventilator support time in the experimental group was shorter than that in the control group [(6.7±2.3) h vs. (7.9±1.4) h], with a statistical difference (n t=2.18, n P=0.03). The levels of CK-MB at T1, T2, T3, and T4 in the experimental group were significantly lower than those in the control group [(22.4±5.3) U/L vs. (27.5±7.7) U/L, (68.5±11.9) U/L vs. (80.4±16.7) U/L, (81.4±21.2) U/L vs. (98.5±34.7) U/L, and (55.9±14.7) U/L vs. (67.3±17.6) U/L], with statistical differences (n t=2.67, 2.84, 2.06, and 2.44; all n P<0.05). The levels of cTnI at T1, T2, T3, and T4 in the experimental group were significantly lower than those in the control group [(7.40±3.10) μg/L vs. (9.90±2.30) μg/L, (6.00±2.20) μg/L vs. (8.90±4.00) μg/L, (6.40±3.30) μg/L vs. (8.60±4.10) μg/L, and (6.80±2.60) μg/L vs. (8.90±3.40) μg/L], with statistical differences (n t=3.17, 3.11, 2.05, 2.40; all n P<0.05). The levels of ATP, ADP, AMP, and CP at T4 in the experimental group were significantly higher than those in the control group, with statistical differences (alln P<0.05). The oxygenation index at T4 in the experimental group was higher than that in the control group [(331.6±43.3) vs. (273.7±33.3)], with a statistical difference (n t=2.90, n P<0.01).n Conclusion:The cold crystal cardioplegic solution with high concentration of potassium containing sodium creatine phosphate can alleviate myocardial ischemia-reperfusion injury in children taking atrio-ventricular septal defect repair under cardiopulmonary bypass and maintain their heart energy supply during myocardial ischemia and the lung oxygenation index after operation, has good cardiopulmonary protection, and is beneficial for their postoperative rehabilitation.