小型猪不停跳心内直视手术麻醉及体外循环管理
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摘要
目的：研究小型猪心脏不停跳心内直视手术的麻醉和体外循环(CPB)管理方法。
方法：小型猪12例,常规建立CPB,阻断上、下腔静脉,不阻断升主动脉,心脏不停跳下行三尖瓣成形术。,采用异氟烷静吸复合麻醉方案。麻醉诱导：氯胺酮3～5 mg·kg-1。肌注,3%戊巴比妥钠15～20 mg·kg-1静注；麻醉维持：异氟烷持续1～1.5最低肺泡气有效浓度(MAC)吸入,间断静脉注射芬太尼15～20 ug·kg-1、维库溴铵0.10～0.15 ug·kg-1和咪唑安定0.1～0.2 mg·kg-1。检测有创动脉血压,动脉血气分析。CPB期间维持肛温35～37℃上,CPB转机流量60～80 ml·kg-1·min-1,平均动脉压(MAP)5.33～9.33 kPa(60～90mmHg),血红蛋白浓度(Hb)60～80g／L,红细胞压积(Hct)25～30%。记录麻醉诱导时间、CPB转机时间、麻醉维持时间、呼吸机辅助时间等,观察CPB期间血流动力学及血气的变化,记录麻醉及CPB相关并发症。
结果：麻醉诱导10.0±2.9 min、CPB转机83.4±8.0 min、麻醉维持248.7±46.8 min、呼吸机辅助344.3±37.5 min。CPB期间血流动力学平稳；乳酸值转机中升高,差异有统计学意义(P<0.05),关胸即刻恢复；Hb及Hct转机后降低(P<0.05),停机后恢复。无窒息、恶性心律失常等并发症发生。死亡3例,其中2例非麻醉及CPB因素,1例死于术后低心排血量综合症。
结论：异氟烷静吸复合麻醉效果稳定,苏醒快；心脏不停跳CPB对呼吸、循环影响小,并发症少。两种技术联合应用,优化了围术期麻醉和CPB管理方案,减少了组织器官的损伤,为心内直视手术较理想的选择。
Objective:To investigate the methods of anesthetic and cardiopulmonary bypass(CPB) management for beating heart surgery in minipigs.
Methods:Twelve minipigs were involved in the experiment, set up CPB plumbing with routine method, blockage superior and inferior vena cava cannulas with out ascending aorta cannula, execution of tricuspid valve plasty with beating heart. The proposal of anesthesia is isoflurane-based inhalated combined intravenous injected, induction with ketamine intramuscular and Pentobarbital injected intravenously; maintenance with isoflurance1.0-1.5MAC inhalated, fentanyl 15-20ug·kg-1·h-1, midazolam 0.1-0.2ug·kg-1·h-1 and pipecuronium 10-0.15ug·kg-1·h-1 injected inconsecutively. Rectal temperature was maintained between 35-37℃during CPB procedure, flow volumes were 60-80 ml·kg-1·h-1,mean arterial blood pressure were 5.33-9.33kPa (60-90mmHg), hemoglobin concentration were 60-80g/L, Hct were 25-30%. Invasive blood pressure, blood gas analysis were detected. Times on induction and maintenance of anesthesia, time of CPB and ventilator procedure were recorded. Complications of anesthesia and CPB were obtained as well.
Results:Time on induction and maintenance of anesthesia were 10.0±2.9min and 83.4±8.0min, time of CPB and ventilator procedure were 248.7±46.8min and 344.3±37.5min, hemodynamics were maintained stabled, lactic acid values were increased signifcantly after CPB cessation and decreased to the foundation level after the period of chest-closed; hemoglobin concentration and Hct were lower during CPB procedure and achived to normal state after CPB cessation.
Conclusion:Isoflurane-based inhalated combined intravenous injected anesthesia were effective, maintained hemodynamics stablely, time on palinesthesia were shorter; CPB procedure has less influence on circulation, respiratory, and tissue metabolism, it takes less complications.The method of anesthetic and CPB management are reasonable choice for open heart operation with beating heart.
方法：小型猪12例,常规建立CPB,阻断上、下腔静脉,不阻断升主动脉,心脏不停跳下行三尖瓣成形术。,采用异氟烷静吸复合麻醉方案。麻醉诱导：氯胺酮3～5 mg·kg-1。肌注,3%戊巴比妥钠15～20 mg·kg-1静注；麻醉维持：异氟烷持续1～1.5最低肺泡气有效浓度(MAC)吸入,间断静脉注射芬太尼15～20 ug·kg-1、维库溴铵0.10～0.15 ug·kg-1和咪唑安定0.1～0.2 mg·kg-1。检测有创动脉血压,动脉血气分析。CPB期间维持肛温35～37℃上,CPB转机流量60～80 ml·kg-1·min-1,平均动脉压(MAP)5.33～9.33 kPa(60～90mmHg),血红蛋白浓度(Hb)60～80g／L,红细胞压积(Hct)25～30%。记录麻醉诱导时间、CPB转机时间、麻醉维持时间、呼吸机辅助时间等,观察CPB期间血流动力学及血气的变化,记录麻醉及CPB相关并发症。
结果：麻醉诱导10.0±2.9 min、CPB转机83.4±8.0 min、麻醉维持248.7±46.8 min、呼吸机辅助344.3±37.5 min。CPB期间血流动力学平稳；乳酸值转机中升高,差异有统计学意义(P<0.05),关胸即刻恢复；Hb及Hct转机后降低(P<0.05),停机后恢复。无窒息、恶性心律失常等并发症发生。死亡3例,其中2例非麻醉及CPB因素,1例死于术后低心排血量综合症。
结论：异氟烷静吸复合麻醉效果稳定,苏醒快；心脏不停跳CPB对呼吸、循环影响小,并发症少。两种技术联合应用,优化了围术期麻醉和CPB管理方案,减少了组织器官的损伤,为心内直视手术较理想的选择。
Objective:To investigate the methods of anesthetic and cardiopulmonary bypass(CPB) management for beating heart surgery in minipigs.
Methods:Twelve minipigs were involved in the experiment, set up CPB plumbing with routine method, blockage superior and inferior vena cava cannulas with out ascending aorta cannula, execution of tricuspid valve plasty with beating heart. The proposal of anesthesia is isoflurane-based inhalated combined intravenous injected, induction with ketamine intramuscular and Pentobarbital injected intravenously; maintenance with isoflurance1.0-1.5MAC inhalated, fentanyl 15-20ug·kg-1·h-1, midazolam 0.1-0.2ug·kg-1·h-1 and pipecuronium 10-0.15ug·kg-1·h-1 injected inconsecutively. Rectal temperature was maintained between 35-37℃during CPB procedure, flow volumes were 60-80 ml·kg-1·h-1,mean arterial blood pressure were 5.33-9.33kPa (60-90mmHg), hemoglobin concentration were 60-80g/L, Hct were 25-30%. Invasive blood pressure, blood gas analysis were detected. Times on induction and maintenance of anesthesia, time of CPB and ventilator procedure were recorded. Complications of anesthesia and CPB were obtained as well.
Results:Time on induction and maintenance of anesthesia were 10.0±2.9min and 83.4±8.0min, time of CPB and ventilator procedure were 248.7±46.8min and 344.3±37.5min, hemodynamics were maintained stabled, lactic acid values were increased signifcantly after CPB cessation and decreased to the foundation level after the period of chest-closed; hemoglobin concentration and Hct were lower during CPB procedure and achived to normal state after CPB cessation.
Conclusion:Isoflurane-based inhalated combined intravenous injected anesthesia were effective, maintained hemodynamics stablely, time on palinesthesia were shorter; CPB procedure has less influence on circulation, respiratory, and tissue metabolism, it takes less complications.The method of anesthetic and CPB management are reasonable choice for open heart operation with beating heart.
引文
1 Warner KG, Khuri SF, Kloner RA, et al.Structural and metabolic correlates of cell injury in the hypertrophied myocardium during valve replacement[J].J Thorac Cardiovasc Surg,1987;93(5):741-754.
2.Lichtenstein SV, Ashe KA, el Dalati H, Cusimano RJ, Panos A, Slutsky AS. Warm heart surgery[J].J Thorac Cardiovasc Surg,1991;101(2):269-274.
3.McGoon MD. Medical treatment of pulmonary hypertension[J]. Cardiologia, 1995;40(8):561-577.
4.何巍.浅低温体外循环心脏跳动中瓣膜置换术的应用与发展[J].继续医学教育,2006；20(10)：53-56.
5.韦世锋,吴文森,陈铭伍.心脏不停跳心内直视手术临床应用[J].广西医学院学报,1993；10(3)：29.
6.王额尔敦,江磊,闫清.温血灌注常温体外循环手术心肌保护研究进展[J].实用医药杂志(山东),2006；23(9)：1129-1131.
7.甄文俊.体外循环心脏手术心肌保护的新进展[J].北京医学,1995；17(5)：287.
8.Lee HT, LaFaro RJ, Reed GE. Pretreatment of human myocardium with adenosine during open heart surgery[J].J Card Surg,1995;10(6):665-676.
9. Martin DR, Scott DF, Downes GL, Belzer FO.Primary cause of unsuccessful liver and heart preservation:cold sensitivity of the ATPase system[J].Ann Surg,1972;175(1):111-117.
10. McMurchie EJ, Raison JK, Cairncross KD. Temperature-induced phase changes in membranes of heart:a contrast between the thermal response of poikilotherms and homeotherms[J].Comp Biochem Physiol B, 1973;44(4):1017-1026.
11.Fuhrman GJ, Fuhrman FA. Utilization of glucose by the hypothermic rat[J]. Am J Physiol,1963;205:181-183.
12.Lyons JM, Raison JK. Oxidative activity of mitochondria isolated from plant tissues sensitive and resistant to chilling injury[J].Plant Physiol, 1970;45(4):386-389.
13.Starr A, Edwards ML.Mitral replacement:the shielded ball valve prosthesis[J]. J Thorac Cardiovasc Surg,1961;42:673-682.
14.Kirklin JW, Kouchoukos NT, Blackstone EH, Oberman A. Research related to surgical treatment of coronary artery disease[J].Circulation, 1979;60(7):1613-1618.
15.Molina JE. Preliminary experience with GORE-TEX grafting for right ventricle-pulmonary artery conduits[J].Tex Heart Inst J,1986;13(1):137-142.
16.张镜芳,建庄,芩坚正.应用体外循环主动脉不阻断法施行小儿法乐氏三联症矫治术[J].中华小儿外科杂志,1995 16(6)：341-343.
17.顾瑞华,昂于,王仲伦.体外循环心脏不停跳心内直视术[J].天津医药,1992；20(2)：105-106.
18.何巍,林辉,覃家锦,等.心脏跳动中房室缺修补术的方法和体会[J].临床心血管杂志,1995；11(4)：114.
19.韦世锋,郑陈光,温仁祝,等.4例常温心脏不停跳情况下二尖瓣替换术[J].中国循环杂志,1995 10(6)：352-353.
20.林辉,蒋宗滨,巍何,等.经冠状静脉窦逆行灌注法在心脏不停跳瓣膜置换术的应用[J].中华麻醉学杂志,1997；17(6)：347-349.
21.王伟,丁文祥,等.常温体外循环[J].中华小儿外科杂志,2002；23(3)：263-264.
22.黄元鲁.温血灌注的心肌保护作用概况[J].右江医学,1997；25(3)：142-144.
23.储荣仁,肖功.浅低温不停跳心肌保护技术用于心脏瓣膜替换手术的临床体会[J].天津医药,1999；27(2)：118-119.
24.何巍,可金星,等.浅低温体外循环心脏跳动中施术对心肌保护的实验研究[J].中华胸心血管外科杂志,2001；17(2)：96-98.
25.康敢军,毛志福,高尚志,等.浅低温体外循环心脏不停跳法围术期细胞因子改变及其意义[J].中华实验外科杂志,2003；20(9)：791-791.
26.Rosenkranz ER, Vinten-Johansen J, Buckberg GD, Okamoto F, Edwards H, Bugyi H. Benefits of normothermic induction of blood cardioplegia in energy-depleted hearts, with maintenance of arrest by multidose cold blood cardioplegic infusions[J].J Thorac Cardiovasc Surg,1982;84(5):667-677.
27.Kertsman VP, Kambarov S,Garsevanov GD, et al.[Retrograde cardioplegia and reperfusion in patients with multiple lesions of the coronary arteries][J]. Grud Serdechnososudistaia Khir,1991(8):16-21.
28.Kiziltepe U, Tunctan B, Eyileten ZB, et al.Efficiency of L-arginine enriched cardioplegia and non-cardioplegic reperfusion in ischemic hearts[J].Int J Cardiol,2004;97(1):93-100.
29. Muraki S,Morris CD, Budde JM, et al.Experimental off-pump coronary artery revascularization with adenosine-enhanced reperfusion[J].J Thorac Cardiovasc Surg,2001;121(3):570-579.
30. Mehlhorn U, Allen SJ, Adams DL, Davis KL, Gogola GR, Warters RD. Cardiac surgical conditions induced by beta-blockade:effect on myocardial fluid balance[J].Ann Thorac Surg,1996;62(1):143-150.
31.Adams JE,3rd, Abendschein DR, Jaffe AS.Biochemical markers of myocardial injury. Is MB creatine kinase the choice for the 1990s?[J]. Circulation,1993;88(2):750-763.
32.Farah B, Vuillemenot A, Lecompte T, et al.Myocardial neutrophil sequestration and activation related to the reperfusion of human heart during coronary artery surgery[J].Cardiovasc Res,1994;28(8):1226-1230.
33.Brown AH, Hassan MA, McMillan AB. Membrane and bubble oxygenators compared by preservation of myocardial function[J].J Cardiovasc Surg (Torino),1979;20(3):233-240.
34.佟宏峰,吴良洪,甄文俊,等.常温体外循环不同灌注量下组织摄氧的研究[J].中华胸心血管外科杂志,1996；12(5)：289.
35.van der Veen FH, van der Vusse GJ, Flameng W, Coumans WA, Reneman RS. Metabolic and haemodynamic changes in the heart during the early phase of cardiopulmonary bypass:I. Clinical observations[J].Cardiovasc Res, 1989;23(6):468-471.
36.Deng YK, Wei F, Li ZL, Zhang DG, Yang SY. Esmolol protects the myocardium and facilitates direct version intracardiac operation with a beating heart[J].Circ J,2002;66(8):715-717.
37.林辉.心脏不停跳心内直视手术[J].广西医科大学学报,1999；16(2)：226.
38.王明德.温血停跳液用于体外循环手术时心肌保护[J].国外医学：麻醉学与复苏分册,1996；17(1)：37-39.
39.Martella AT, Hoffman DM, Nakao T, Frater RW. Continuous normothermic retrograde cardioplegia for valve surgery [J]. J Heart Valve Dis, 1994;3(4):404-409.
40.Calafiore AM, Teodori G, Bosco G, et al. Intermittent antegrade warm blood cardioplegia in aortic valve replacement J]. J Card Surg,1996;11(5):348-354.
41.Julia PL, Buckberg GD, Acar C, Partington MT, Sherman MP. Studies of controlled reperfusion after ischemia. XXI.Reperfusate composition: superiority of blood cardioplegia over crystalloid cardioplegia in limiting reperfusion damage--importance of endogenous oxygen free radical scavengers in red blood cells[J].J Thorac Cardiovasc Surg, 1991;101(2):303-313.
42.朱水波,殷桂林.浅低温体外循环不阻断主动脉心内直视手术的评价[J].中华实验外科杂志,1997；14(6)：381-382.
43.林善昌,何魏,陈铭伍,等.浅低温体外循环心脏不停跳心内直视手术2962例临床研究[J].中国实用医药,2009；4(1)：6-8.
44.Matsumoto Y, Watanabe G, Endo M, Sasaki H, Kasashima F, Kosugi I. Efficacy and safety of on-pump beating heart surgery for valvular disease[J]. Ann Thorac Surg,2002;74(3):678-683.
45.林辉,何巍,郑陈光.心脏不停跳法防止换瓣术后低心排血量综合征的研究[J].中华实验外科杂志,1998；15(1)：44-45.
46.张海洲,薛涛,郭兰敏.浅低温心脏不停跳心内直视手术对心肌保护作用的研究[J].山东医药,2003；40(30)：6-8.
47.张海洲,郭兰敏,邹承伟,等.不停跳心内直视手术对心肌损伤的探讨[J].新医学,2005；36(3)：140-142.
48.熊利华,苏艳玲,华平,等.不停跳心内直视术的临床研究[J].中山大学学报·医学科学版,2004；28(3)：221-223.
49.杜德禄,李俊杰,张长江,等.心脏不停跳心内直视手术治疗先天性心脏病[J].实用儿科临床杂志,2005；20(6)：601-602.
50.Wan IY, Arifi AA, Wan S, et al. Beating heart revascularization with or without cardiopulmonary bypass:evaluation of inflammatory response in a prospective randomized study[J].J Thorac Cardiovasc Surg, 2004;127(6):1624-1631.
51.王咏,肖颖彬,陈林.先天性心脏病心内直视手术术后心电图分析[J].中国急救医学,2005；25(2)：84-85.
52.汪斌,李朝先,向小勇.心脏停跳和跳动下二尖瓣置换术病人心肌TNF及线粒体的变化[J].第三军医大学学报,2002；24(6)：735-737.
53.Napoli C,Cicala C, Wallace JL, et al. Protease-activated receptor-2 modulates myocardial ischemia-reperfusion injury in the rat heart[J].Proc Natl Acad Sci USA,2000;97(7):3678-3683.
54.向道康,阎兴治,蔡鸿,等.心脏不停跳心内直视手术与神经元损伤[J].中华胸心血管外科杂志,2002；18(4)：220-222.
55.Kurrelmeyer KM, Michael LH, Baumgarten G, et al.Endogenous tumor necrosis factor protects the adult cardiac myocyte against ischemic-induced apoptosis in a murine model of acute myocardial infarction[J].Proc Natl Acad Sci USA,2000;97(10):5456-5461.
56.何二宁,冯旭,曾建业,等.心脏不停跳手术盐酸氨溴索干预对患者血浆细胞因子及血栓前列环素的影响[J].广西医学,2006；28(5)：638-640.
57.邱志兵,陈鑫,李朝先,等.浅低温体外循环心脏跳动二尖瓣置换术对心肌保护的体视学研究[J].中国危重病急救医学,2005；17(9)：533-536.
58.陈林,肖颖彬,王学峰,等.先天性心脏病心脏停跳和不停跳下心内直视手术的临床分析[J].第三军医大学学报,2000；22(11)：1056-1058.
59.孙益峰,梅运清,王玺胜,等.心脏不停跳心内直视手术113例[J].同济大学学报·医学版,2007；28(4)：75-77.
60.陈龙,杨玲.三种心肌保护方法对长时间停搏心脏功能恢复的影响[J].第二军医大学学报,1999；20(8)：554-556.
61.陈长春,姬尚义,王湘,等.全身常温、心脏低温体外循环在先天性心脏病外科中的应用[J].中国胸心血管外科临床杂志,2006；13(1)：18-20.
62.Taggart DP. Influence of perfusion technique and pH management strategy during coronary artery bypass surgery[J].J Thorac Cardiovasc Surg, 1996;111(4):900-901.
63.Roberts J, Chen B, Curtis LM, Agarwal A, Sanders PW, Zinn KR. Detection of early changes in renal function using 99mTc-MAG3 imaging in a murine model of ischemia-reperfusion injury[J].Am J Physiol Renal Physiol, 2007;293(4):F1408-1412.
64.杨文凯,王文英,杨生萍,等.不同灌注方式在低温体外循环下冠状动脉 搭桥术中心肌酶谱变化的比较[J].江西医药,2008；43(10)：1044-1045.
65.Chen XG, Wu BY, Wang JK, Bai T. [Mechanism of the protective effects of noninvasive limbs preconditioning on myocardial ischemia-reperfusion injury.][J]. Chin Med J (Engl),2005;118(20):1723-1727.
66. Minami K, Omoto T, Bothig D, et al. Creatine kinase and troponin after myocardial preservation using HTK solution (Custoidol) for clinical heart transplantation[J].J Heart Lung Transplant,2003;22(2):192-194.
67.Suzuki K, Sawa Y, Kadoba K, et al.[The earlier detection of myocardial damage in open heart surgery using serum human heart fatty acid-binding protein][J]. Nippon Kyobu Geka Gakkai Zasshi,1996;44(6):760-764.
68. Buckberg GD. Normothermic blood cardioplegia. Alternative or adjunct?[J].J Thorac Cardiovasc Surg,1994;107(3):860-867.
69.Torchiana DF, Vine AJ, Titus JS, et al.The temperature dependence of cardioplegic distribution in the canine heart[J].Ann Thorac Surg, 2000;70(2):614-620.
70. Lin JC, Apple FS, Murakami MM, Luepker RV. Rates of positive cardiac troponin I and creatine kinase MB mass among patients hospitalized for suspected acute coronary syndromes[J]. Clin Chem,2004;50(2):333-338.
71.Kini AS, Lee P, Marmur JD, et al. Correlation of postpercutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality[J]. Am J Cardiol,2004;93(1):18-23.
72.谢晓阳,李朝先,向小勇,等.浅低温心脏不停跳心内直视手术心肌保护的微观研究[J].中华实验外科杂志,2001；18(5)：473.
73.吴海波,何学志.浅低温心脏不停跳瓣膜置换手术的生化学研究[J].医师进修杂志,2005；6(28)：5.
74.周晓彤,涛薛,王志萍,等.浅低温心脏不停跳心内直视手术对心肌酶学和超微结构的影响[J].江苏医药杂志,2003；29(9)：674-677.
75.李世康,何巍,陈铭伍,等.逆行灌注心脏不停跳双瓣膜置换术围术期心肌细胞凋亡及Bc1-2, Bax的表达[J].中国胸心血管外科临床杂志,2006；13(5)：10.
76.刘学刚,李兴武,唐震,等.浅低温心脏不停搏心内手术对心肌保护效果的比较[J].蚌埠医学院学报,2002；27(3)：201-204.
77.肖颖彬,陈林,王学锋,等.浅低温体外循环心脏跳动中心内直视手术1032例临床分析[J].第三军医大学学报,2001；23(5).
78.时加伦,田步升.浅低温心脏不停跳心内直视手术临床分析[J].长治医学院学报,2004；3(1)：18.
79.王忠明,张剑平.浅低温心脏不停跳心内直视手术141例[J].中国胸心血管外科临床杂志,1999；5(6)：2.
80. Takahashi T, Kadoba K, Taniguchi K, et al.Repair of postinfarction ventricular septal defect on a beating heart[J]. Ann Thorac Surg, 1996;61(6):1816-1817.
81. Sweeney MS, Frazier OH. Device-supported myocardial revascularization: safe help for sick hearts[J]. Ann Thorac Surg,1992;54(6):1065-1070.
82.方海宁,吴锋耀,冯琦云,等.浅中低温体外循环不阻断心肌血流心内直视手术的临床对比研究[J].中国心血管病研究杂志,2005；3(12)：915-917.
83.吴锋耀,方海宁,冯绮云,等.体外循环下不停跳及持续逆灌心肌保护效果临床研究[J].中国体外循环杂志,2005；3(3)：172-175.
2.Lichtenstein SV, Ashe KA, el Dalati H, Cusimano RJ, Panos A, Slutsky AS. Warm heart surgery[J].J Thorac Cardiovasc Surg,1991;101(2):269-274.
3.McGoon MD. Medical treatment of pulmonary hypertension[J]. Cardiologia, 1995;40(8):561-577.
4.何巍.浅低温体外循环心脏跳动中瓣膜置换术的应用与发展[J].继续医学教育,2006；20(10)：53-56.
5.韦世锋,吴文森,陈铭伍.心脏不停跳心内直视手术临床应用[J].广西医学院学报,1993；10(3)：29.
6.王额尔敦,江磊,闫清.温血灌注常温体外循环手术心肌保护研究进展[J].实用医药杂志(山东),2006；23(9)：1129-1131.
7.甄文俊.体外循环心脏手术心肌保护的新进展[J].北京医学,1995；17(5)：287.
8.Lee HT, LaFaro RJ, Reed GE. Pretreatment of human myocardium with adenosine during open heart surgery[J].J Card Surg,1995;10(6):665-676.
9. Martin DR, Scott DF, Downes GL, Belzer FO.Primary cause of unsuccessful liver and heart preservation:cold sensitivity of the ATPase system[J].Ann Surg,1972;175(1):111-117.
10. McMurchie EJ, Raison JK, Cairncross KD. Temperature-induced phase changes in membranes of heart:a contrast between the thermal response of poikilotherms and homeotherms[J].Comp Biochem Physiol B, 1973;44(4):1017-1026.
11.Fuhrman GJ, Fuhrman FA. Utilization of glucose by the hypothermic rat[J]. Am J Physiol,1963;205:181-183.
12.Lyons JM, Raison JK. Oxidative activity of mitochondria isolated from plant tissues sensitive and resistant to chilling injury[J].Plant Physiol, 1970;45(4):386-389.
13.Starr A, Edwards ML.Mitral replacement:the shielded ball valve prosthesis[J]. J Thorac Cardiovasc Surg,1961;42:673-682.
14.Kirklin JW, Kouchoukos NT, Blackstone EH, Oberman A. Research related to surgical treatment of coronary artery disease[J].Circulation, 1979;60(7):1613-1618.
15.Molina JE. Preliminary experience with GORE-TEX grafting for right ventricle-pulmonary artery conduits[J].Tex Heart Inst J,1986;13(1):137-142.
16.张镜芳,建庄,芩坚正.应用体外循环主动脉不阻断法施行小儿法乐氏三联症矫治术[J].中华小儿外科杂志,1995 16(6)：341-343.
17.顾瑞华,昂于,王仲伦.体外循环心脏不停跳心内直视术[J].天津医药,1992；20(2)：105-106.
18.何巍,林辉,覃家锦,等.心脏跳动中房室缺修补术的方法和体会[J].临床心血管杂志,1995；11(4)：114.
19.韦世锋,郑陈光,温仁祝,等.4例常温心脏不停跳情况下二尖瓣替换术[J].中国循环杂志,1995 10(6)：352-353.
20.林辉,蒋宗滨,巍何,等.经冠状静脉窦逆行灌注法在心脏不停跳瓣膜置换术的应用[J].中华麻醉学杂志,1997；17(6)：347-349.
21.王伟,丁文祥,等.常温体外循环[J].中华小儿外科杂志,2002；23(3)：263-264.
22.黄元鲁.温血灌注的心肌保护作用概况[J].右江医学,1997；25(3)：142-144.
23.储荣仁,肖功.浅低温不停跳心肌保护技术用于心脏瓣膜替换手术的临床体会[J].天津医药,1999；27(2)：118-119.
24.何巍,可金星,等.浅低温体外循环心脏跳动中施术对心肌保护的实验研究[J].中华胸心血管外科杂志,2001；17(2)：96-98.
25.康敢军,毛志福,高尚志,等.浅低温体外循环心脏不停跳法围术期细胞因子改变及其意义[J].中华实验外科杂志,2003；20(9)：791-791.
26.Rosenkranz ER, Vinten-Johansen J, Buckberg GD, Okamoto F, Edwards H, Bugyi H. Benefits of normothermic induction of blood cardioplegia in energy-depleted hearts, with maintenance of arrest by multidose cold blood cardioplegic infusions[J].J Thorac Cardiovasc Surg,1982;84(5):667-677.
27.Kertsman VP, Kambarov S,Garsevanov GD, et al.[Retrograde cardioplegia and reperfusion in patients with multiple lesions of the coronary arteries][J]. Grud Serdechnososudistaia Khir,1991(8):16-21.
28.Kiziltepe U, Tunctan B, Eyileten ZB, et al.Efficiency of L-arginine enriched cardioplegia and non-cardioplegic reperfusion in ischemic hearts[J].Int J Cardiol,2004;97(1):93-100.
29. Muraki S,Morris CD, Budde JM, et al.Experimental off-pump coronary artery revascularization with adenosine-enhanced reperfusion[J].J Thorac Cardiovasc Surg,2001;121(3):570-579.
30. Mehlhorn U, Allen SJ, Adams DL, Davis KL, Gogola GR, Warters RD. Cardiac surgical conditions induced by beta-blockade:effect on myocardial fluid balance[J].Ann Thorac Surg,1996;62(1):143-150.
31.Adams JE,3rd, Abendschein DR, Jaffe AS.Biochemical markers of myocardial injury. Is MB creatine kinase the choice for the 1990s?[J]. Circulation,1993;88(2):750-763.
32.Farah B, Vuillemenot A, Lecompte T, et al.Myocardial neutrophil sequestration and activation related to the reperfusion of human heart during coronary artery surgery[J].Cardiovasc Res,1994;28(8):1226-1230.
33.Brown AH, Hassan MA, McMillan AB. Membrane and bubble oxygenators compared by preservation of myocardial function[J].J Cardiovasc Surg (Torino),1979;20(3):233-240.
34.佟宏峰,吴良洪,甄文俊,等.常温体外循环不同灌注量下组织摄氧的研究[J].中华胸心血管外科杂志,1996；12(5)：289.
35.van der Veen FH, van der Vusse GJ, Flameng W, Coumans WA, Reneman RS. Metabolic and haemodynamic changes in the heart during the early phase of cardiopulmonary bypass:I. Clinical observations[J].Cardiovasc Res, 1989;23(6):468-471.
36.Deng YK, Wei F, Li ZL, Zhang DG, Yang SY. Esmolol protects the myocardium and facilitates direct version intracardiac operation with a beating heart[J].Circ J,2002;66(8):715-717.
37.林辉.心脏不停跳心内直视手术[J].广西医科大学学报,1999；16(2)：226.
38.王明德.温血停跳液用于体外循环手术时心肌保护[J].国外医学：麻醉学与复苏分册,1996；17(1)：37-39.
39.Martella AT, Hoffman DM, Nakao T, Frater RW. Continuous normothermic retrograde cardioplegia for valve surgery [J]. J Heart Valve Dis, 1994;3(4):404-409.
40.Calafiore AM, Teodori G, Bosco G, et al. Intermittent antegrade warm blood cardioplegia in aortic valve replacement J]. J Card Surg,1996;11(5):348-354.
41.Julia PL, Buckberg GD, Acar C, Partington MT, Sherman MP. Studies of controlled reperfusion after ischemia. XXI.Reperfusate composition: superiority of blood cardioplegia over crystalloid cardioplegia in limiting reperfusion damage--importance of endogenous oxygen free radical scavengers in red blood cells[J].J Thorac Cardiovasc Surg, 1991;101(2):303-313.
42.朱水波,殷桂林.浅低温体外循环不阻断主动脉心内直视手术的评价[J].中华实验外科杂志,1997；14(6)：381-382.
43.林善昌,何魏,陈铭伍,等.浅低温体外循环心脏不停跳心内直视手术2962例临床研究[J].中国实用医药,2009；4(1)：6-8.
44.Matsumoto Y, Watanabe G, Endo M, Sasaki H, Kasashima F, Kosugi I. Efficacy and safety of on-pump beating heart surgery for valvular disease[J]. Ann Thorac Surg,2002;74(3):678-683.
45.林辉,何巍,郑陈光.心脏不停跳法防止换瓣术后低心排血量综合征的研究[J].中华实验外科杂志,1998；15(1)：44-45.
46.张海洲,薛涛,郭兰敏.浅低温心脏不停跳心内直视手术对心肌保护作用的研究[J].山东医药,2003；40(30)：6-8.
47.张海洲,郭兰敏,邹承伟,等.不停跳心内直视手术对心肌损伤的探讨[J].新医学,2005；36(3)：140-142.
48.熊利华,苏艳玲,华平,等.不停跳心内直视术的临床研究[J].中山大学学报·医学科学版,2004；28(3)：221-223.
49.杜德禄,李俊杰,张长江,等.心脏不停跳心内直视手术治疗先天性心脏病[J].实用儿科临床杂志,2005；20(6)：601-602.
50.Wan IY, Arifi AA, Wan S, et al. Beating heart revascularization with or without cardiopulmonary bypass:evaluation of inflammatory response in a prospective randomized study[J].J Thorac Cardiovasc Surg, 2004;127(6):1624-1631.
51.王咏,肖颖彬,陈林.先天性心脏病心内直视手术术后心电图分析[J].中国急救医学,2005；25(2)：84-85.
52.汪斌,李朝先,向小勇.心脏停跳和跳动下二尖瓣置换术病人心肌TNF及线粒体的变化[J].第三军医大学学报,2002；24(6)：735-737.
53.Napoli C,Cicala C, Wallace JL, et al. Protease-activated receptor-2 modulates myocardial ischemia-reperfusion injury in the rat heart[J].Proc Natl Acad Sci USA,2000;97(7):3678-3683.
54.向道康,阎兴治,蔡鸿,等.心脏不停跳心内直视手术与神经元损伤[J].中华胸心血管外科杂志,2002；18(4)：220-222.
55.Kurrelmeyer KM, Michael LH, Baumgarten G, et al.Endogenous tumor necrosis factor protects the adult cardiac myocyte against ischemic-induced apoptosis in a murine model of acute myocardial infarction[J].Proc Natl Acad Sci USA,2000;97(10):5456-5461.
56.何二宁,冯旭,曾建业,等.心脏不停跳手术盐酸氨溴索干预对患者血浆细胞因子及血栓前列环素的影响[J].广西医学,2006；28(5)：638-640.
57.邱志兵,陈鑫,李朝先,等.浅低温体外循环心脏跳动二尖瓣置换术对心肌保护的体视学研究[J].中国危重病急救医学,2005；17(9)：533-536.
58.陈林,肖颖彬,王学峰,等.先天性心脏病心脏停跳和不停跳下心内直视手术的临床分析[J].第三军医大学学报,2000；22(11)：1056-1058.
59.孙益峰,梅运清,王玺胜,等.心脏不停跳心内直视手术113例[J].同济大学学报·医学版,2007；28(4)：75-77.
60.陈龙,杨玲.三种心肌保护方法对长时间停搏心脏功能恢复的影响[J].第二军医大学学报,1999；20(8)：554-556.
61.陈长春,姬尚义,王湘,等.全身常温、心脏低温体外循环在先天性心脏病外科中的应用[J].中国胸心血管外科临床杂志,2006；13(1)：18-20.
62.Taggart DP. Influence of perfusion technique and pH management strategy during coronary artery bypass surgery[J].J Thorac Cardiovasc Surg, 1996;111(4):900-901.
63.Roberts J, Chen B, Curtis LM, Agarwal A, Sanders PW, Zinn KR. Detection of early changes in renal function using 99mTc-MAG3 imaging in a murine model of ischemia-reperfusion injury[J].Am J Physiol Renal Physiol, 2007;293(4):F1408-1412.
64.杨文凯,王文英,杨生萍,等.不同灌注方式在低温体外循环下冠状动脉 搭桥术中心肌酶谱变化的比较[J].江西医药,2008；43(10)：1044-1045.
65.Chen XG, Wu BY, Wang JK, Bai T. [Mechanism of the protective effects of noninvasive limbs preconditioning on myocardial ischemia-reperfusion injury.][J]. Chin Med J (Engl),2005;118(20):1723-1727.
66. Minami K, Omoto T, Bothig D, et al. Creatine kinase and troponin after myocardial preservation using HTK solution (Custoidol) for clinical heart transplantation[J].J Heart Lung Transplant,2003;22(2):192-194.
67.Suzuki K, Sawa Y, Kadoba K, et al.[The earlier detection of myocardial damage in open heart surgery using serum human heart fatty acid-binding protein][J]. Nippon Kyobu Geka Gakkai Zasshi,1996;44(6):760-764.
68. Buckberg GD. Normothermic blood cardioplegia. Alternative or adjunct?[J].J Thorac Cardiovasc Surg,1994;107(3):860-867.
69.Torchiana DF, Vine AJ, Titus JS, et al.The temperature dependence of cardioplegic distribution in the canine heart[J].Ann Thorac Surg, 2000;70(2):614-620.
70. Lin JC, Apple FS, Murakami MM, Luepker RV. Rates of positive cardiac troponin I and creatine kinase MB mass among patients hospitalized for suspected acute coronary syndromes[J]. Clin Chem,2004;50(2):333-338.
71.Kini AS, Lee P, Marmur JD, et al. Correlation of postpercutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality[J]. Am J Cardiol,2004;93(1):18-23.
72.谢晓阳,李朝先,向小勇,等.浅低温心脏不停跳心内直视手术心肌保护的微观研究[J].中华实验外科杂志,2001；18(5)：473.
73.吴海波,何学志.浅低温心脏不停跳瓣膜置换手术的生化学研究[J].医师进修杂志,2005；6(28)：5.
74.周晓彤,涛薛,王志萍,等.浅低温心脏不停跳心内直视手术对心肌酶学和超微结构的影响[J].江苏医药杂志,2003；29(9)：674-677.
75.李世康,何巍,陈铭伍,等.逆行灌注心脏不停跳双瓣膜置换术围术期心肌细胞凋亡及Bc1-2, Bax的表达[J].中国胸心血管外科临床杂志,2006；13(5)：10.
76.刘学刚,李兴武,唐震,等.浅低温心脏不停搏心内手术对心肌保护效果的比较[J].蚌埠医学院学报,2002；27(3)：201-204.
77.肖颖彬,陈林,王学锋,等.浅低温体外循环心脏跳动中心内直视手术1032例临床分析[J].第三军医大学学报,2001；23(5).
78.时加伦,田步升.浅低温心脏不停跳心内直视手术临床分析[J].长治医学院学报,2004；3(1)：18.
79.王忠明,张剑平.浅低温心脏不停跳心内直视手术141例[J].中国胸心血管外科临床杂志,1999；5(6)：2.
80. Takahashi T, Kadoba K, Taniguchi K, et al.Repair of postinfarction ventricular septal defect on a beating heart[J]. Ann Thorac Surg, 1996;61(6):1816-1817.
81. Sweeney MS, Frazier OH. Device-supported myocardial revascularization: safe help for sick hearts[J]. Ann Thorac Surg,1992;54(6):1065-1070.
82.方海宁,吴锋耀,冯琦云,等.浅中低温体外循环不阻断心肌血流心内直视手术的临床对比研究[J].中国心血管病研究杂志,2005；3(12)：915-917.
83.吴锋耀,方海宁,冯绮云,等.体外循环下不停跳及持续逆灌心肌保护效果临床研究[J].中国体外循环杂志,2005；3(3)：172-175.