摘要
目的比较Del Nido心脏停搏液与冷含血停搏液在复杂心脏手术中的心肌保护效果。方法回顾性分析2018年1月至2019年10月体外循环(CPB)下行复杂心脏手术(主动脉阻断时间>120 min)75例患者的病例资料,按照使用的心肌保护液不同将其分为Del Nido停搏液组37例和冷含血停搏液组38例。收集两组患者身体质量指数(BMI)、术前及术后射血分数(EF)、体外循环时间、主动脉阻断时间、后并行时间、停搏液灌注次数及总量、两组心脏的自动复跳率、除颤率、术后24 h和术后48 h血清肌钙蛋白(cTnT)和肌酸磷酸激酶同工酶(CKMB)浓度,术后机械通气时间、ICU滞留时间、术后住院时间、术后正性肌力药物使用天数、术后肝肾功能等临床资料。结果两组患者均顺利完成手术。A组的后并行时间、停搏液灌注次数、除颤率明显低于B组,差异有统计学意义(P<0.05,P<0.01)。A组术后24 h、48 h CKMB、cTnT水平较B组明显降低,差异有统计学意义(P<0.05,P<0.01)。结论 Del Nido心脏停搏液与冷含血停搏液相比,在复杂心脏手术中,前者灌注次数更少,除颤率更低,后并行时间更短,术后24 h、48 h CKMB、cTnT水平明显降低,心肌保护效果要优于冷含血停跳液。Del Nido心脏停搏液在复杂心脏手术中的临床应用是安全可行的。
Objective To compare the myocardial protective effects of del Nido cardioplegia and cold blood cardioplegia in complex cardiac surgery.Methods Seventy-five patients who received complex cardiac surgery(aortic occlusion time>120 min)under cardiopulmonary bypass(CPB)from January 2018 to October 2019 were retrospectively studied.The patients were divided into del Nido cardioplegia group(n=37)and cold blood cardioplegia group(n=38)according to the different myocardial protective fluids used.The body mass index(BMI),preoperative and postoperative ejection fraction(EF),extracorporeal circulation(ECC)time,aortic occlusion time,post-parallel cycle time,number and total amount of cardioplegia,automatic rebound rate,defibrillation rate,serum levels of cardiac troponin T(cTnT)and creatine phosphokinase isoenzyme(CKMB)at 24-and 48-hour after surgery,postoperative mechanical ventilation,residence time in ICU,postoperative hospitalization time,use of positive inotropic drug after operation,postoperative liver and kidney function and other clinical data were collected and observed in two groups.Results All operations were successfully completed in two groups.The post-parallel cycle time,perfusion times of cardioplegia,defibrillation rate and the levels of CKMB and cTnT at 24-and 48-hour after surgery in group A were significantly lower than those in group B(P<0.05,P<0.01).Conclusion Compared with cold blood cardioplegia solution,del Nido cardioplegia solution has advantages of fewer perfusion times,lower defibrillation rate,shorter parallel time,lower CKMB and cTnT levels at 24 and 48 hours after operation and better myocardial protection effect.The clinical application of del Nido cardioplegia is safe and feasible in complex cardiac surgery.
作者
焦思杨
刘琳
马路遥
郑翔翔
秦建伟
JIAO Si-yang;LIU Lin;MA Lu-yao;ZHENG Xiang-xiang;QIN Jian-wei(Department of Cardiovascular Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)
出处
《中国临床研究》
CAS
2020年第6期807-810,共4页
Chinese Journal of Clinical Research
