血清酵素活性値からみた成人開心術症例における術中心筋保護法の比較検討
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概要
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This study is to evaluate three different methods of myocardial protection during open heart surgery for adult patients with ischemic heart disease or valvular heart disease. The objects consisted of 52 patients who underwent aorto-coronary bypass and 49 patients Who underwent valvular surgeries during a past decade. Three different methods of myocardial protection were employed as follows: Group 1 : general hypothermia (30℃〜32℃) + intermittent aortic corss clamp, group 2 : general hypothermia + aortic cross clamp + topical cardiac cooling by chilled lactated Ringers solu tion, Group 3 : general hypothermia + aortic cross clamp + cold cardioplegic solution with St. Thomas Hospital solution + topical cardiac cooling by ice slush. The activity levels of CPK, GOT, LDH and GPT in serum were measured before and after surgery. Following conclusions were obtained : 1) No death was obtained in group 2 and group 3 but three patients died in group 1 after A-C bypass. 2) The peak of activity levels of CPK, GOT and LDH, after cardiac surgery revealed lower values in group 3 compared with that of group 1 (P<0.05). 3) Postoperative enzyme activity expressed as a one-minute value of aortic cross clamp revealed lower values of CPK, GOT, LDH and GPT in group 3 than those in group 1 (P<0.05). 4) Abnormally high activity levels of these enzymes were observed in three cases of perioperative myocardial infarction. On the basis of these findings, it was proposed that the diagnosis of perioperative myocardial infarction should be made when the activity levels in serum enzymes exceeded the following values that is, CPK over 1300 IU/l (22 IU/l/min.), GOT over 300KU (5 KU/min.), LDH over 1200 wu/ml (20wu/ml/min) in association with newly developed abnormal Q on ECG.
- 神戸大学の論文