2018-03-2001:26:12中国现代医生2018年1期黄伟聪陆地程德志孙成超表1两组手术情况组别n体外循环时间(min)主动脉阻断时间(min)自动/除颤复跳实验组3296.32±1.8067.10±2」028/4*对照组2696.43±2.1064.52±2.0219/7注:与对照组比较，:PvO.05表2两组心肌生化指标结果指标组别nT1CK-MB(U/L)实验组328.80±0.121(对照组269.72±0.101(cTnI(|JLg/L)实验组324.75±0.034对照组264.84±0.024［摘要］目的探討经冠状静脉窦逆行灌注在主动脉瓣置换手术中心肌保护的有效性。方法纳入我院2016年1〜12月行主动脉瓣置换手术患者58例，进行围术期心肌保护研究。根据术中心脏灌注停跳方式随机将患者分为两组：顺行性灌注组(对照组，n=26),主动脉根部或径冠状动脉开口顺行性灌注冷血心脏停搏液；顺+逆行灌注组(实验组，n=32),顺行灌注诱导心脏停搏，再经冠状静脉窦逆行灌注。观察两组患者早期临床疗效，用术期指标的变化情况。结果两组58例患者均安全度过围术期，未出现死亡及重要脏器损害等并发症。实验组手术效果更佳，术中心脏自动复跳率、复跳后ST段改变指标显著优于对照组，差异有统计学意义(PvO.05)。两组体外循环时间、主动脉阻断时间、术后血清肌钙蛋口l(cTnl)、肌酸激酶同功酶(CK-MB)指标比较无显著性差异(P>0.05)。结论经冠状静脉窦逆行灌注在主动脉瓣辻换手术中能够安全的应用，该方法心肌保护确切，且可避免损伤冠脉开口，避免因心肌肥厚或冠脉狭窄导致的术中灌注不足等严重并发症的产生。［关键词］心肺转流；心肌保护；心脏瓣膜置换；冠状静脉窦灌注［中图分类号］R654.2［文献标识码］B［文章编1673-9701(2018)01-0049-03ApplicationofretrogradecoronarysinusperfusioninaorticvalvereplacementsurgeryHUANGWeicongLUDiCHENGDezhiSUNChengchaoDepartmentofCardiothoracicSurgery,theFirstAffiliatedHospitalofWenzhouMedicalUniversity,Wenzhou325000,China［Abstract］ObjectiveToinvestigatetheeffectivenessofretrogradecoronarysinusperfusioninmyocardialprotect!onduringaorticvalvereplacement.Methods58patientsundergoingaorticvalvereplacementsurgeryinourhospitalfromJanuarytoDecember2016wereselected・Thestudyofperioperativemyocardialprotectionwascarriedout.Accordingtothewayofintraoperativeheartperfusionarrest,thepatientswererandomlydividedintotwogroups：Anterogradeinfusiongroup(controlgroup,n二26),aorticrootordiametercoronaryarteryanterogradeperfusionofcoldbloodcardioplegicsolution；anterograde+retrogradeperfusiongroup(experimentalgroup,n=32),antegradeperfusion-inducedcardiacarrest,followedbyretrogradeperfusionviacoronarysinus.Theearlyclinicalefficacyandthechangesofperioperativeindiceswereobservedinthetwogroupsofpatients.ResultsAllthe58patientssafelypassedtheperioperativeperiodinbothgroups,andtherewerenocomplicationssuchasdeathandvitalorgandamage.Theexperimentalgrouphadbetteroperativeeffect.Theintraoperativeauto-rebeatrateofheartandchangesofSTindexafterrebeatweresignificantlybetterthanthoseinthecontrolgroup,andthedifferencewasstatisticallysignificant(P<0.05).Therewasnosignificantdiffereneeinthelevelsofdurationofardiopulmonarybypass,timeofaortaocclusion,postoperativeserumtroponinI(cTnl)andcreatinekinaseisoenzyme(CK-MB)betweenthetwogroups(P>0.05).ConclusionRetrogradeperfusionviacoronarysinuscanbeusedsafelyinaorticvalvereplacementsurgery.Themethodofmyocardialprotectionisaccurate,andcanavoiddamagetothecoronaryopening,avoidintraoperativehypoperfusionandotherseriouscomplicationsduetocardiachypertrophyorcoronarystenosis.［Keywords］Cardiopulmonarybypass：Cardiacprotection；Cardiacvalvereplacement；Coronarysinusperfusion主动脉瓣病变常引起左心室压力和容量负荷增加，可导致心肌肥厚，严重者可并发急性心肌梗死、充血性心力衰竭等严重...