del Nido和HTK停搏液在成人左心室肥厚患者心脏手术中心肌保护效果的比较
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R514

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江苏省基础研究计划(自然科学基金)(BK20201084);“临床能力提升工程”医疗项目(JSPH-MC-2020-9)


Comparison of the myocardial protective effects of del Nido and HTK cardioplegia in adult patients with left ventricular hypertrophy undergoing cardiac surgery
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    摘要:

    目的:探讨del Nido停搏液和组氨酸-色氨酸-酮戊二酸(histidine-tryptophan-ketoglutarate,HTK)停搏液在左心室肥厚(left ventricular hypertrophy,LVH)患者行心内直视手术中的临床应用效果。方法:回顾性收集2021年1月—2022年12月在南京医科大学第一附属医院心脏大血管外科进行心脏体外循环手术的LVH患者75例,根据术中使用停搏液类型分为del Nido 组(D组,39例)和HTK组(H组,36例)。比较两组患者一般资料、手术麻醉与体外循环资料、术后临床资料及围术期心肌标志物改变等。结果:升主动脉开放后,D组室颤发生率低于H组(P< 0.01)。发生室颤患者中,D组的室颤持续时间、除颤次数和除颤能量均低于H组(P< 0.05)。D组复跳时间长于H组(P< 0.05),D组临时起搏器使用率高于H组(P< 0.05)。体外循环结束后15 min,D组血管活性药评分(vasoactive-inotropic score,VIS)高于H组(P< 0.001);而手术结束前15 min以及术后6 h两组 VIS评分比较,差异无统计学意义(P > 0.05)。在心肌标志物方面,仅发现术后24 h,H组肌酸激酶同工酶(creatine kinase-MB, CK-MB)和肌钙蛋白T(cardiac troponin T,cTnT)高于D组(P< 0.05);两组术后48 h心肌标志物比较,差异无统计学意义(P > 0.05)。结论:del Nido停搏液和HTK停搏液均可安全用于LVH患者术中心肌保护,但使用HTK停搏液,主动脉开放后室颤发生率更高,术后24 h CK-MB及cTnT高于del Nido停搏液;而使用del Nido停搏液,心脏复跳时间更长,临时起搏器使用率更高,且停机后15 min时的血管活性药使用量高于HTK停搏液。

    Abstract:

    Objective:To explore the clinical application effects of del Nido and histidine-tryptophan-ketoglutarate(HTK) cardioplegia in patients with left ventricular hypertrophy(LVH)undergoing open-heart surgery. Methods:A total of 75 LVH patients who underwent cardiopulmonary bypass(CPB)surgery in our hospital from January 2021 to December 2022 were retrospectively collected and were divided into del Nido group(group D,39 cases)and HTK group(group H,36 cases)according to the type of cardioplegia used during open-heart surgery. General information,interoperative anesthesia and cardiopulmonary bypass data, postoperative clinical information,and changes in perioperative myocardial markers were compared between the two groups. Results: After releasing aortic cross-clamp(ACC),the incidence of ventricular fibrillation(VF)was lower in the group D than in the group H (P< 0.01). Among patients with VF,the duration of VF,defibrillation times,and defibrillation energy were lower in the group D than in the group H(P< 0.05). The group D had a longer time for spontaneous heart rhythm recovery than the group H(P< 0.05),and the temporary pacemaker usage rate was higher in the group D than in the group H(P< 0.05).The group D had a higher vasoactive-inotropic score(VIS)score 15 minutes after the end of CPB than the group H(P< 0.001),while there was no significant difference in VIS scores between the two groups 15 minutes before the end of the operation and 6 hours after the operation(P > 0.05). In terms of myocardial markers,only at 24 hours after surgery,the levels of creatine kinase isoenzymes-MB(CK-MB)and cardiac troponin T(cTnT) were higher in the group H than in the group D(P< 0.05);there was no significant difference in myocardial markers between the two groups at 48 hours after surgery(P > 0.05). Conclusion:Both del Nido and HTK cardioplegia can be safely used for myocardial protection in patients with LVH during surgery. However,the use of HTK cardioplegia is associated with a higher incidence of VF after ACC removal and higher levels of CK-MB and cTnT at 24 hours after surgery compared to del Nido cardioplegia. On the other hand,the use of del Nido cardioplegia is associated with a longer time to recovery of spontaneous heart rhythm,a higher temporary pacemaker usage rates,and a higher doses of vasoactive drugs at 15 minutes after ACC removal compared with HTK cardioplegia.

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方印,俞敏,周晓凯. del Nido和HTK停搏液在成人左心室肥厚患者心脏手术中心肌保护效果的比较[J].南京医科大学学报(自然科学版),2024,(2):210-217

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  • 收稿日期:2023-06-29
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  • 在线发布日期: 2024-02-05
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