论文部分内容阅读
本文对７例进行换瓣手术的风湿性心脏病患者，采用冷钾稀释血冠状静脉窦逆行灌注方法保护心肌，同时利用ＨＰＬＣ检测了手术不同时点心肌能量有关物质的变化，并以此为指标评价顺灌与逆灌的保护效果。结果提示，逆灌较顺灌保护效果好。表现为逆灌时，手术过程中各时点（除停跳立即外，缺血４０分钟，复跳立即，复跳２０分钟）ＰＣｒ检测表现值各时点比顺灌时高；ＡＴＰ检测表现值在复跳２０分钟时逆灌明显高于顺灌，ＡＤＰ和ＮＡＤ检测的表现值各时点有增加趋势，ＴＡＮ与能荷变化趋势与此类似。与此相反ＨＹＰＯ和ＡＭＰ检测表观值则呈降低之趋势。上述结果说明冷钾稀释血逆灌时，心肌氧化磷酸化作用加强，ＮＡＤ和ＡＤＰ增加，有利于ＡＴＰ和ＰＣｒ的合成，可进一步改善心肌能量代谢。
In this paper, seven patients with rheumatic heart disease undergoing valve replacement surgery were treated with cold-potassium diluted coronary sinus retrograde perfusion to protect myocardium. Meanwhile, the change of myocardial energy-related substances at different time points was detected by HPLC, Evaluate the protective effect of irrigation and irrigation. The results suggest that the reverse irrigation is better than the irrigation protection. The performance of the anti-irrigation, the surgery at all times (except immediately stop jumping, ischemia for 40 minutes, jump immediately, re-jump 20 minutes) PCr test performance values at various time points than irrigation; ATP test performance values In 20 minutes after jumping back was significantly higher than cis-irrigation, ADP and NAD detection performance values at all times have an increasing trend, TAN and energy charge trend with this similar. In contrast, the apparent values of HYPO and AMP showed a decreasing trend. The above results show that cold potassium dilute blood anti-retrograde irrigation, myocardial oxidative phosphorylation strengthened, NAD and ADP increased, is conducive to the synthesis of ATP and PCr, can further improve myocardial energy metabolism.