摘要
目的康斯特保护液（HTK液）作为心脏停搏液与晶体停搏液作用的比较。方法2012年4月-2012年6月期间在我院住院行体外循环心外直视手术治疗的患者中年龄在6个月以内共106例，术中应用ST．ThomasⅡ晶体停搏液（A组）24例，应用HTK液（B组）82例。病种有室间隔缺损、房间隔缺损、法洛氏四联症、右室双出口、单心室、完全性房室隔缺损等。灌注方法：两组麻醉方式相同，体外循环采用中度低温，肛温30℃时阻断升主动脉，同时主动脉根部顺行灌注。A纽按20m／／kg体重灌注ST．ThomasⅡ晶体停搏液一次；HTK液组用5～8℃的HTK液以80～90mmHg的压力灌注到心脏停搏后改为30～40mmHg的压力维持，共灌注6min，如果升主动脉阻断时间超过180min．或出现心电活动再进行2～3min灌注。观察的指标：在麻醉后、术后24小时及72小时外周血血清的肌钙蛋白I（cTnI）和肌酸磷酸激酶同工酶B（CKMB）、乳酸脱氢酶（LDH）浓度，和手术时升主动脉阻断钳开放后的自动复跳率、术后监护天数、术前及术后当天左室射血分数（EF）。结果自发性复跳率和术后监护的天数无明显差别．术后当天左室EFB组优于A组，B组术后24小时血清cTnI及CKMB、LDH浓度低于A组，但术后72小时浓度比较无统计学意义。结论HTK液对未成熟心肌的保护作用明显优于传统的ST．ThomasI／液。
Objective To summarize the protection effect of HTK solution on immature myocardium in cardiac opera- tion of infants. Methods 106 infants with congenital heart disease operated from April 2012 to June 2012, were divided into two groups ： ST. Thomas Ⅱ solution group （ group A） and HTK group （ group B）. The age at cardiac operation was below 6 months. The diagnosis included ventricular septal defect （ VSD ）, atrial septal defect （ ASD ）, tetralogy of Follot （ TOF）, double outlet right ventricle （DORV）, single ventricle （SV） , compiete atrioventricular septal defect （CAVC） , etc. The mod- erate hypothermia was maintained during CPB. In the group A, myocardial perfusion during CPB was dependent on dose -20ml/ kg, single time. In the group B, it was dependent on perfusion pressure 80 to 90mmHg to make cardiac arrest, and the maintai- ning pressure was 30 to 40mmHg, and the whole time was 6 rain. The time to collect blood sample was after anesthesia, 24 and 72 hours after operation. We measured the serum level of cardiac troponin I （ cTn I ）, creative kinase MB （ CKMB）, and lactate dehydrogenase （LDH）. Clinical parameters including the auto-resucitation ratio, inotropic support requirement, me- chanical ventilation duration, and the stay time in the intensive care unit were recorded. Ejection fraction （EF） was measured preoperatively. Results The level of CKMB, LDH and cTn I in group B at the timing 24 hours after operation were lower than that in group A. In the clinical parameters, the EF showed that the myocardial damage in group B were less than that in group A. Conclusion The protective effects of HTK solution on immature myocardial in infants with congenital heart disease is obviously better than ST. Thomas Ⅱ solution.
出处
《广州医药》
2014年第1期8-11,共4页
Guangzhou Medical Journal
关键词
心肌灌注
心肌保护
先天性心脏病婴幼儿
未成熟心肌
Myocardial perfusion
Myocardial protection
Congential heart disease
Infants
Immature myocardium
